LIBRARY 
 
 UNIVERSITY OF CALIFORNIA 
 RIVERSIDE 
 
HEALTH AND EMPIRE 
 
PREACHING INOCULATION 
 Outside a Small, Plague-stricken Town in the Punjab. 
 
 (The preacher is a missionary, and the picture illustrates two vital principles tiiat the 
 
 essence of health-promotion is education of the public, and that the chief 
 
 agents must be those most in touch with its daily life.) 
 
A TRAVELLER'S STUDY OF 
 
 HEALTH AND EMPIRE 
 
 BY 
 
 FRANCIS FREMANTLE 
 ifl 
 
 COUNTY MEDICAL OFFICER OF HEALTH 
 Author of "A Doctor in Khaki" 
 
 " Salus populi suprema lex " 
 
 LONDON 
 
 JOHN OUSELEY LTD. 
 FLEET LANE, FARRINGDON STREET, E.G. 
 
DEDICATED BY PERMISSION TO 
 
 THE STATESMAN-PIONEER 
 
 OF A HEALTHY EMPIRE 
 
 THE RIGHT HON. JOSEPH CHAMBERLAIN, M.P. 
 
 BY ONE OF HIS MANY 
 YOUNG DISCIPLES AND FOLLOWERS 
 
LIST OF ILLUSTRATIONS 
 
 1. Preaching inoculation outside a small plague- 
 
 stricken town in the Punjab .... Frontispiece 
 
 2. Zenana work at Tarn-Taran : (a) Saved from 
 
 leprosy ; (b} Saved from famine . . To face page 15 
 
 3. (a) The medical man of India and his dispensary 
 
 in the street ; (b} In the Lunatic Asylum of 
 
 Lahore ..,..... 16 
 
 4. (a) Inoculation against plague ; (b} Boys in the 
 
 school-yard await their turn . . . ,, 18 
 
 5. Disinfection out in the forest . . . 40 
 
 6. Disposal of Sewage : (a) Bullock-cart for removal 
 
 of slops; (b) New septic tank for Simla . ,, 48 
 
 7. Water-supply: (a) A roadside well by Dehli; 
 
 () A Persian wheel in Lahore . . ,, 49 
 
 8. The verandah at Kasauli 75 
 
 9. (a) The Colonel injects enough poison to kill 
 
 6000 ponies ; (b} Milking a cobra at Parel . ,, ,, 82 
 
 10. Women washing in the slums of Bombay . ,, 95 
 
 11. Slums of Winnipeg in the making . . ,, ,, 146 
 
 12. Sewage disposal on the rice-fields of Japan . ,, 190 
 
 13. An episode in the Russo-Japanese War: (a) 
 
 Russian forage smouldering and Chinese 
 junks waiting for loot ; (b) The first Japanese 
 scouts into Niu-chwang . . . . ,, 201 
 
 14. Discharging wounded from the Hospital-ship 
 
 Kobe Maru at Sasebo . . . . 205 
 
 15. A modern Buddhist cathedral in Japan : (a) The 
 
 Higashi Hongwanji, Kyoto, built in 1895; 
 (b) The interior, the congregation and the 
 image displayed 286 
 
 16. San Francisco : (a) Outwardly, in Market Street ; 
 
 (b) Inwardly, where plague broke out in the 
 
 old Globe Hotel, Chinatown . . . 307 
 
CONTENTS 
 
 PAGE 
 
 PREFACE ....... ix 
 
 THE ARGUMENT ...... i 
 
 CHAPTER 
 
 I. THE CRY OF THE PLAGUE-STRICKEN PUNJAB . 13 
 
 FOOTNOTE ON SANITATION . . . .49 
 
 II. BRITISH RULE AND THE GAMBLE IN LIFE . 50 
 
 III. THE MAD DOG . . . . , 63 
 
 IV. THE FLEA . . . . .88 
 V. BERI-BERI . . . . .100 
 
 VI. "SEEK AND YE SHALL FIND" . . ; , 109 
 
 VII. MALAYA AND THE SCIENCE OF TOWNING . .126 
 
 VIII. HOUSING AND THE FUTURE OF HONG-KONG . 149 
 
 IX. SCHOOLS AND PUBLIC HEALTH IN JAPAN . .176 
 
 X. THE EVACUATION OF NIU-CHWANG . .194 
 
 XL THE NAVAL HOSPITAL AT SASEBO . . . 205 
 
 XII. JAPANESE RED CROSS . . . .221 
 
 XIII. THE AFTERMATH OF THE RUSSO-JAPANESE WAR . 254 
 
 XIV. RELIGION IN THE FAR EAST . . .274 
 XV. HEALTH-FAKING IN SAN FRANCISCO . . 293 
 
 XVI. FEDERAL HYGIENE IN THE STATES . . 315 
 
 XVII. MR. CHAMBERLAIN'S SPEECHES . . 331 
 
 XVIII. CONCLUSION HEALTH AND THE BRITISH EMPIRE 347 
 
 vii 
 
PREFACE 
 
 CIRCUMSTANCES and a kindly master in the shape of a 
 County Council enabled the author of this book in 
 1903 to leave his work in charge of a deputy and to 
 set off on eighteen months' travel. His direct object 
 was to study the wider problems of health and 
 empire, in other climates, in other races and under 
 other systems of government, and so to fit himself, 
 should occasion arise, for parliamentary service. His 
 ultimate aim was and will ever be to persuade the 
 public of the significance of those problems and 
 to secure a due attention to their solution in the 
 future administration of the British Empire. 
 
 A year was allotted to wider travel, six months to 
 study in countries nearer home. The chief extreme 
 from conditions at home would be found in the 
 Asiatic tropics, where orderly government and primi- 
 tive conditions of life would give the basis of numbers, 
 variation and administrative experience required. 
 It seemed best then to concentrate on India, and 
 there, as an integral part of the sanitary administra- 
 tion, to study one district first for a whole winter's 
 season, for one season's visitation of the plague. 
 The governments of India and of the Punjab were 
 
most helpful in advancing this plan. " In six 
 months," said a high official in Simla, " you will 
 know more of Indian problems than any but a dozen 
 members or so of the House of Commons." The 
 exaggeration was a pledge of interest ; but no one 
 certainly, when once a Member of Parliament and 
 man of rank, can obtain in a mere visit an equally 
 intimate experience of Indian life and rule. More- 
 over the pay of a plague medical officer is ample and 
 is a useful subscription to the traveller's purse. 
 
 A winter was the result in the Lahore and Amritsar 
 districts, and then a dash from Lahore to Peshawar 
 and the Afghan frontier, through Lahore again south- 
 eastwards to Calcutta. There was no time to lose, 
 for war had broken out in the Far East. Visits were 
 paid in passing to various cities and lands, Burmah, 
 the Malay States, Singapore, French Cochin-China, 
 Hong-Kong, Canton, Shanghai, Japan, and so to 
 the seat of war. Physicians and surgeons in every 
 hospital, workers in every laboratory, medical officers 
 of health in every port and town unlocked the secrets 
 of each place in turn ; the hospitality and friendship 
 surpassed those of freemasonry and can never be 
 repaid. A short experience of war, of Northern 
 China and again of Japan completed the Asiatic 
 chapter. Passing by the Hawaii Islands, America 
 was entered at San Francisco ; and a few weeks 
 spent in passing up the west coast to Vancouver, 
 
PREFACE xi 
 
 over the Rockies, across the prairies to Winnipeg ; 
 down to Chicago and St. Louis for the world's fair ; 
 across to catch the spirit of health administration 
 in three or four cities in the eastern states. A last 
 winter was sufficient for the purpose in view in Paris, 
 Geneva, Berlin and Hamburg and certain towns on 
 and off the way. 
 
 This book, written for general rather than pro- 
 fessional consumption, is designed to carry a reader, 
 perhaps only tepidly interested in his country's 
 welfare, through the more intense and profitable 
 experiences of the traveller, without the travel's 
 drawbacks. It does not profess fully and scientific- 
 ally to prove the statement that its title would 
 suggest. But it expects to be read with common 
 intelligence and an open mind, and trusts that the 
 reader will then agree as if from personal experience 
 in the fundamental importance to a modern empire of 
 attention to the public health. 
 
 Thanks are due to Mr. Chamberlain for permission 
 to dedicate the book to him, for a kindly expression 
 of sympathy with its aim and for the dates of his 
 speeches in point ; but infinitely more for those 
 speeches themselves and the inspiration thus given 
 to medical officers of health in their work and ideals 
 on behalf of the state. 
 
 Grateful acknowledgment is due to The Times, The 
 Lancet, The National Revieiv and The Civil and 
 
xii PREFACE 
 
 Military Gazette of Lahore for permission to republish ; 
 to Professor W. J. Simpson, the first living expert in 
 imperial health, for advice and assistance ; and to 
 various friends of all races and degrees for their help 
 towards the fascinating experiences that have re- 
 sulted in this book 
 
 An Imperial Conference and the crowning of a new 
 King have marked this year in the history of the 
 British Empire. The future of our empire will rest, 
 it is said, on treaties, tariffs, and defence. These 
 pages seek to show that defence of health is as im- 
 portant as defence of territory. For disease is a 
 deadlier foe than man ; health and morale give 
 greater strength than armaments. And mutual 
 effort throughout the sister-dominions of the crown 
 will be far more effective than independent action 
 in building up the imperial strength and in diminish- 
 ing the piteous tale of sickness and misery, of weak- 
 ness, inefficiency and death. 
 
 The attention of all has been called to the heritage 
 of empire. In a few weeks attention will be diverted 
 to holidays and health. It is hoped that this book 
 may aptly combine the two ideas and bring home to 
 those who are well and strong the importance of the 
 physical asset to the security of our empire. 
 
 FRANCIS FREMANTLE. 
 22nd June 1911. 
 
HEALTH AND EMPIRE 
 
 THE ARGUMENT 
 
 TURN over the fat, blue, repellent volume of figures 
 issued by the Registrar-General every year and on 
 page 112 of the last Report, that for 1909, you will 
 find the Birth-rates and Death-rates of thirty-four 
 different countries for the last twenty-nine years. 
 Here are the actual facts, that record the strength 
 and weakness, the rise and fall in human strength 
 of the modern world. 
 
 Here we have the preliminary mandate for the 
 Public Health Service, by which it shall direct nations 
 how to be fruitful and replenish the earth, to conserve 
 their human asset, to diminish their tale of sickness, 
 which is strength and labour lost, to promote and 
 strengthen life and to postpone death. 
 
 Here we see the British death-rate reduced from 
 
 20 deaths every year out of 1000 living in 1891 to 
 15 in 1908 ; the Australian death-rate reduced from 
 15 to 10 ; the German from near 25 to 18 ; the 
 French from 23 to 19 ; while the Japanese rate is still 
 
 21 and the Russian 30. What individual sickness 
 and suffering do these figures represent ! What 
 national weakness and loss of productive power ! 
 How much might have been prevented ! How much 
 
2 HEALTH AND EMPIRE 
 
 may in the future be prevented ! What promise 
 for those nations that recognise, those individuals 
 who desire to utilise, the value of health to empire ! 
 
 But of what value is all this talk of empire, if we 
 can promise no manhood and womanhood for its 
 development ? Here then on this same page 112, of 
 world-wide moment, let us notice, not only the general 
 reduction of the death-rate, which has its inevitable 
 limits, but an equally general reduction in the birth- 
 rate, which knows no bounds. A quarter of a century 
 back 1000 Britishers brought into the world over 
 32 young Britishers every year to carry on and 
 develop the work of the 19 who died. Now, to 
 replace the 15 that die, only 26 enter the lists. The 
 Australian rate is reduced to 25 ; the French to 20 ; 
 while the German is still 32, the Russian 48 and the 
 Japanese, alone of all nations, has risen from 25 to 
 34 ay, and may continue to rise. 
 
 A vivid scene may attract attention ; and the 
 scheme of the book opens in its first chapter with 
 the impression of six winter months spent in a life 
 and death struggle with plague in the Punjab, a 
 gigantic struggle far more deadly than any war 
 in which over 7,000,000 have lost their lives in the 
 last fourteen years, and to which we see at present no 
 ending. We are at once face to face with the health 
 responsibilities and vulnerability of the Empire. 
 
 An experience of this sort, in individual and daily 
 touch with Indian village life as a responsible officer 
 of the imperial administration, gives an opportunity, 
 unusual to a traveller whether medical or lay, of 
 estimating the value of British rule. Chapter II. 
 
THE ARGUMENT 3 
 
 shows in certain respects the success of this rule and 
 at the same time the inevitable dissatisfaction of an 
 Oriental in being thus deprived of his gamble in life, 
 a fact which is seldom realised by Europeans at home 
 in considering the dilemmas of eastern government. 
 
 The third chapter introduces the scourge of hydro- 
 phobia and the miraculous saving of life affected in 
 India by science and government ; the fourth shows 
 the light now shed by the same means in Bombay 
 and Hong-Kong on the cause of plague, an essential 
 preliminary to its extinction ; the fifth deals with 
 another imperial danger in the disease named kakke 
 or beri-beri in Singapore and Kuala Lumpur, the 
 fascinating capital of the Malay States. 
 
 Here, as also in the sixth chapter, the direct value 
 to the state of properly equipped scientific research, 
 the essential preliminary to efficient measures against 
 disease, is further illustrated by the French hospital 
 at Saigon, the laboratory of the international muni- 
 cipality at Shanghai and the Japanese Institute at 
 Tokyo, in which the plan of campaign was being 
 prepared not only against the plague, snake-poison, 
 kakke and hydrophobia, but also against smallpox, 
 erysipelas, tuberculosis and diphtheria ; against 
 cholera, typhoid, dysentery and anthrax ; against 
 glanders and tetanus in the horse ; against rinderpest 
 in cattle ; against the destructive action of red ants 
 on sugar-cane and other diseases of plants, grains and 
 trees. With this is contrasted an abortive scheme of 
 vaccination instituted by the late Corean authorities. 
 
 The seventh chapter, in discussing the development 
 of the Malay States, deals with a detail of sanitary 
 
4 HEALTH AND EMPIRE 
 
 progress, now much to the front at home, the healthy 
 and economic planning of towns in advance, as 
 illustrated by Kuala Lumpur, their capital ; the 
 eighth shows the difficulty of housing and the oppor- 
 tunity of town-planning in the further development 
 of the colony of Hong-Kong. 
 
 The ninth chapter gives glimpses farther east of 
 education and public health in Japan, a country to 
 which we may well look for new applications of 
 European methods, where the start is made with open 
 minds, a clean slate and a hearty and progressive 
 public spirit. 
 
 Here we are at the theatre of war ; and war, the 
 historic foundation-stone of nations, the struggle for 
 existence, the avenue for commercial development 
 and social progress, preaches us a most striking 
 sermon on the value, the national necessity, of medical 
 work and above all of the prevention of disease. 
 
 Chapter X. gives an epitome of the war in the 
 graphic incident of the battle at Ta'hsi Chiao and the 
 evacuation of Niuchwang, reprinted by kind per- 
 mission from The Times. 
 
 The proprietors of The National Review have 
 allowed the reproduction in Chapter XL of an article 
 describing the chief Japanese naval hospital, in 
 charge of an English-trained Surgeon-General, as 
 a type of the several that were visited by the 
 courtesy of the Foreign Office at Tokyo and the 
 British Ambassador. Chapter XII. shows the re- 
 markable organisation of the Japanese Red Cross. 
 
 Chapter XIII. suggests the aftermath of the Russo- 
 Japanese war ; and Chapter XIV., as its corollary, 
 
THE ARGUMENT 5 
 
 is based on a paper read before the Christian Con- 
 ference on religion in the far east. These chapters 
 are not wholly irrelevant to the theme ; for war, 
 diplomacy and spiritual strength are essentially 
 related to the public health ; and he would indeed 
 have a warped mind who witnessed such scenes as 
 those described without including them in his estimate 
 of imperial strength. 
 
 Chapter XV. takes us to America, where the 
 commercial value of a reputation for health was 
 attested by the action of the late Mayor Eugen 
 Schmitz, who declared that plague was not plague, 
 and was defeated in his perversion of the truth only 
 by Federal action on firm administrative and sound 
 scientific lines. Corruptio veri pessima ; in lesser 
 degree the same truth holds good in English ad- 
 ministration of public health. 
 
 A chapter on Federal Hygiene in the States supplies 
 an example for the co-operation of all constituent 
 communities and the practical utilisation of the 
 health information at their command in the future 
 development of our own empire. 
 
 Space has prevented any adequate account of 
 further experiences; and it seemed best to omit 
 them; for the new Encyclopaedia itself would not 
 contain the books that should be written on the 
 themes that presented themselves of slums in 
 Winnipeg, of meat and twenty-three languages in 
 Chicago, of tall houses and boulevards, the excep- 
 tional care of the public health in Massachusetts, and 
 other American conceptions on the grand scale ; of 
 school-feeding and Continental schools ; of Geneva 
 
6 HEALTH AND EMPIRE 
 
 and the milk-supply; in France, of the struggle 
 against tuberculosis, the cleanly streets and sewerage 
 of Paris, the municipal slaughter-houses, the river- 
 side ambulance stations, the state protection of 
 destitute infants, the Assistance Publique and the 
 Public Health Law of 1902; in Germany, of school- 
 hygiene, milk-supply, the museums of public health, 
 national insurance against accidents and sickness, 
 and the housing philanthropy of the Krupp family 
 at Essen. 
 
 If the microscope is essential for the scientific 
 progress of public health, there is still more need 
 of telescopic study in administrative methods and 
 practical experiments. Hitherto content with local 
 experience, pioneers and teachers of Public Health 
 must in future adopt a more cosmopolitan method. 
 This subject is a study of empires, not villages ; of all 
 climates, not one; of all races, all conditions, all times. 
 
 What then is the profession of Public Health ? 
 It is the cure of bodies in the mass ; it is the charge of 
 the primary forces of the nation, which correspond 
 directly to their environment and are capable of 
 gradual atrophy through neglect or of almost infinite 
 development by the light of modern knowledge ; of 
 forces on which in almost direct proportion depend 
 the effective commercial, mental, spiritual power of 
 the country ; of forces which should be the first care 
 of government and often have been its last ; which 
 can be and actually are in large measure affected by 
 legislation and which, if rightly used, should become 
 the chief corner-stone of the Empire. 
 
 Life is a battle and the battle is to the strong. 
 
THE ARGUMENT 7 
 
 Health, hitherto regarded with benevolence as an 
 ornament, must henceforth be counted a weapon 
 essential to every part of the national life. Health 
 to a nation is as vital as good material to an engine ; 
 as exact alloy to a coin. It can be trained and 
 developed to increase the output ten and a hundred 
 fold both in variety and in degree. But left to itself 
 it is neglected, forgotten ; it loses power and the 
 public wonder at the failure of the national machine, 
 which appears to their diverted attention so full of 
 wonder and promise. 
 
 An offensive policy is the best defence. A healthy 
 body will best cope with disease. But prevention of 
 disease, as of war, has none of the tragic pomp and 
 glory that attract attention to its cure. Prevention 
 of sickness in the individual implies constant self- 
 restraint and a careful habit of life. Prevention of 
 sickness in the community implies wise statesman- 
 ship, detailed perseverance and mutual co-operation 
 between statesmen, officials and the people. The 
 care of personal health is civilised selfishness in its 
 logical extreme. The care of the public health is the 
 very incarnation of reasoning unselfishness. 
 
 The instincts of animal man lead him to struggle 
 for food, physical pleasure and existence ; lead him 
 to cultivate personal health for those ends. The 
 instincts of civilised man teach him that mutual 
 support may replace competition ; prompt him to 
 congregate and move freely amongst his fellows, and 
 to co-operate for the public health. The health of 
 the individual has been ever an axiom of human life ; 
 the health of the community has been an occasional 
 
8 HEALTH AND EMPIRE 
 
 instrument, rediscovered in times of need by great 
 statesmen and soldiers, and soon again returned to 
 the dusty shelf. The baths and aqueducts of Rome, 
 that brought three hundred gallons of water a day 
 for every inhabitant ; the detailed rules of the 
 Levitic code for cleanliness and for the avoidance 
 of infection, fill with surprise the Londoner, content 
 with his thirty gallons and grumbling in wilful 
 ignorance against the new-fangled by-laws of his 
 Borough Council. 
 
 But now the tide again is turning ; the health of 
 the community holds in increasing degree the atten- 
 tion of the legislature, the executive and the public. 
 Disraeli was probably the first prime minister in re- 
 corded history to pronounce with all the authority 
 of his office the supreme importance of the popular 
 health. The interests of the working classes were, 
 he declared, paramount, and the working man's 
 health was his greatest asset. It was he that gave 
 public health its magna charta and created the 
 present sanitary authorities in the Act of 1875 ; it 
 was Lord Salisbury that created county councils 
 in 1888 ; Mr. Gladstone, parish councils in 1894 ; and 
 during the last twenty-five years big acts and little 
 acts, by-laws and regulations have been formulated 
 in bewildering confusion. A codifying, unifying and 
 extending measure is urgently needed. 
 
 The community pays for these measures by an 
 increase in the rates ; but their effect has been a very 
 large reduction in the amount of sickness and in the 
 number of deaths, with the consequent average 
 addition of five years to every infant's expectation of 
 
THE ARGUMENT 9 
 
 life. During the last twenty years the death-rate 
 for England and Wales has fallen from 20 to 13-4 per 
 1000 per annum. In every 1000 of the population, 
 therefore, 6 or 7 lives or, in a population of 35,000,000, 
 over 120,000 lives are saved every year. It will be 
 remembered too, that a low rate of sickness and 
 death means increased health and spirits to all, 
 greater happiness and a larger capacity for work. 
 The friendly societies tell us that thirteen times as 
 much work-time is lost by sickness as by death. 
 
 But this improvement in the national well-being 
 is not by any means entirely due to the law or to the 
 sanitary officials and authorities that administer and 
 execute it. A large share of credit must be given to 
 the people themselves, who in their societies and 
 papers, their schools, their family life, are learning 
 more and more to inculcate, at least on each other, 
 the lessons of sound health. Medical officers, in 
 this respect, are preachers, content to see their ideals 
 gaining ground, without receiving much share of 
 public recognition. The vast importance of this lay 
 co-operation must never be forgotten. It is a better 
 stepping-stone to the attainment of the ideal than 
 any number, however efficient, of acts, regulations 
 or officials. 
 
 Yet, despite the facts, the public health has not 
 attained proper recognition. Soldiers, politicians, 
 preachers, councillors, seldom refer to the subject 
 except as a question of mere humanity. Humanity 
 it undoubtedly is. But humanity plays only a minor 
 part in the rivalry, on which prosperity of com- 
 munities must in this life depend. For this end the 
 
10 HEALTH AND EMPIRE 
 
 nation aims at the maximum of effective output with 
 the minimum of effort. The output varies im- 
 mediately with the health and strength of the nation ; 
 efficiency and economy of effort vary with its in- 
 telligence and education. Health is possible without 
 education, but education is impossible without 
 health. And so, for mere national efficiency, the 
 public health is of all things most important. 
 
 Times without number has the influence of health 
 on military operations asserted itself in an extreme 
 degree. The Assyrians before Samaria, the ill-fated 
 Walcheren expedition, our South African army at 
 Bloemfontein, the standing camp of the United 
 States army in its war with Spain, are illustrations 
 only confirmed by the attention paid to the pre- 
 servation of health in the Manchurian army of the 
 ever-zealous Japanese. 
 
 Time and time again have nations suffered the 
 most serious loss through epidemic or endemic 
 scourges of disease. The 7,000,000 of lives lost 
 through the epidemic of plague, now again on the 
 increase in India ; the losses from malaria, yellow 
 fever, blackwater, sleeping sickness or other tropical 
 diseases, which till the end of the last century made 
 tropical possessions the most expensive jewels in an 
 imperial crown ; the decimation by disease of the 
 labourers on the Panama Canal, that defeated De 
 Lesseps and ruined his magnificent project ; are 
 they not sufficient evidence of the value of health 
 to empire ? 
 
 But now the curtain is lifting. We have the keys 
 to the cause of the plague, the cause of malaria, the 
 
THE ARGUMENT 11 
 
 cause of yellow fever, the cause of sleeping sickness ; 
 and in some cases we already know how to fit the key 
 in the- lock, to turn it and open the gate. In others, 
 as in smallpox, we can open the gate without a key. 
 And so we can let in the floods of health ; and so 
 Dr. Gorgas, by his medical dictatorship, has enabled 
 the United States to triumph where De Lesseps 
 failed, and has taught the world that attention to the 
 public health is the avenue to achievements and to 
 wealth beyond the dreams of avarice. 
 
 If such are the striking lessons of the tropics, such 
 also are the lessons here at home. We, too, have our 
 preventable deaths and ailments, due largely to the 
 artificial growth of town life ; we, too, at home suffer 
 incalculable loss and misery from unnecessary sick- 
 ness ; the effect being only hidden by the very con- 
 gestion that is its cause and by the comparative 
 immunity from the wars and pestilence of old days. 
 But our empire calls aloud for men ; and as in the 
 tropics, so also at home by earnest, instead of half- 
 hearted, attention to the public health, we could 
 halve our losses, double our output, quadruple our 
 personal security and happiness and increase a 
 hundredfold our strength in the undeveloped fields 
 of work which have been committed for a season 
 to our charge. The battle is to the strong. 
 
 So ends this book with Mr. Chamberlain's pro- 
 nouncements, with an outline of policy for advance- 
 ment of the imperial health, and above all with an 
 earnest appeal for thought and attention to the health 
 of the community, as the essential basis of empire 
 on sure and progressive lines. 
 
CHAPTER I 
 
 THE CRY OF THE PLAGUE-STRICKEN PUNJAB 
 
 "Dr. F. is requested to proceed without delay to Amritsar and 
 report himself to the Civil Surgeon for inoculation work in 
 the Tarn-Taran tehsil." 
 
 THIS order reached me by special messenger in the 
 wilds of the Lahore district. I was sitting alone in 
 a solitary vacant official bungalow in comfort and 
 grey flannels before a blazing fire, after a drive in 
 pelting rain to an infected village, which refused all 
 my offers of help, charmed I never so wisely. This 
 year, 1903-1904, we offered help ; the winter before 
 our predecessors gave it without much asking. We 
 offered help ; pointed out the hundreds of villages 
 infected, the thousands dying daily, the myriads 
 that had died since plague attacked the Punjab in 
 1896. We offered inoculation and told tales of the 
 Bombay jail, where under the same conditions most 
 of the inoculated escaped and most of the un- 
 inoculated died ; tales of the little villages like 
 Wirana close by, where only five frightened females, 
 fleeing at the approach of the inoculator, escaped 
 inoculation and only those five females died. Statis- 
 tics are useless ; the Indian peasant is imaginative 
 and likes tales, which must be graphic and need not 
 be scientifically correct as is nevertheless the tale 
 13 
 
14 
 
 of Wirana. We talked by means of our keen young 
 Mohammedan munshi, who, being of high family and 
 descended from AH, the Prophet's favourite nephew, 
 carried weight with the strict Mussulman ; or we 
 talked through our energetic young Sikh compounder, 
 who, wearing his hair uncut and twisted up in a knot 
 inside his turban, wearing the comb, the drawers, the 
 steel bangle and steel miniature knife, the five signs, 
 with the uncut hair, of a true Sikh, was able to appeal 
 to the prejudices of the Sikh ; or, in default of either, 
 we talked through our Goanese bearer or valet, who, 
 Mahratta with a touch of Portuguese in him, Roman 
 Catholic, and attired like an Italian organ-grinder, 
 carried weight with all natives as a member of the 
 aristocracy. A smattering of Urdu enabled one to 
 keep watch over their interpreting ; and the intervals 
 were useful for reflection, which is an essential part 
 of the native's method for the exchange of ideas. 
 We talked rather than harangued ; we drew on the 
 local schoolmaster or village officials or greybeards 
 to ask questions and state objections, and so by 
 degrees we fancied ourselves able sometimes to sow 
 a little good seed. If inoculation seemed a bad card 
 to play, we tried a stronger card and suggested 
 evacuation of the village ; and if popular feeling, or, 
 as in the present case, the elements were "against 
 evacuation, we fell back on systematic disinfection. 
 If the villagers had had experience of chemical dis- 
 infection and did not like it, we suggested disin- 
 fection by heat. And if they refused all these 
 measures, we proposed that they should wait till 
 one out of every four of their friends, their relatives, 
 
-. 
 c = 
 
 E 2. 
 
 
 "S 
 
 IB | -I 
 
 x- ii 
 
 "S>'3%^? Q<*4 
 S ^3T 
 
 ^-t .- ^ r/~j ^ ^ 
 
THE PLAGUE-STRICKEN PUNJAB 15 
 
 themselves had died, and then should apply to the 
 Civil Surgeon of the district to come and save the 
 rest. Meanwhile we had no desire to interfere with 
 their liberty of dying or to undertake extra work ; 
 and so we wished them good-day. 
 
 A nine-mile drive through the rain in a rickety 
 country cart, splashing through the mud, soaked 
 through to the skin, escorted half the way by a couple 
 of strapping fellows, who ride bareback behind us 
 waiting for the honour of an English salaam, brings 
 us eventually to the railway munshi, compounder, 
 bearer, cook, bedding, inoculation and disinfection 
 outfit, personal baggage, a couple of carts and drivers 
 and myself ; and picking up my pony and syce and 
 my bicycle on the way at Lahore, we take orders 
 from the civil-surgeon at Amritsar and ride and drive 
 out the fifteen miles to Tarn-Taran. 
 
 Tarn-Taran, a little town of under 4000, is one of 
 the centres of the Sikh religion ; and twice a year 
 a crowd of nearly 100,000 congregates there to 
 bathe in the tank of the Golden Temple. It is 
 the centre of a large Sikh district and the head- 
 quarters of a C.M.S. and a Zenana Mission (Plate 2), 
 whose guiding star is a jovial, athletic, devoted 
 English padre, still young after twenty-three (now 
 thirty) years' work in the country. Knowing the 
 people intimately, through constant visits to the 
 370 villages of his beat, acquainted with every man 
 of the meanest position who has grown up during 
 his time, and on good terms with all but a few slinking 
 knaves, who have felt his firm hand, President of 
 the Municipality and trusted by Sikh and Christian 
 
16 HEALTH AND EMPIRE 
 
 alike, he has asked for an English inoculating 
 officer to work with him during this season of the 
 epidemic. 
 
 English he must be, for the natives do not trust a 
 native, however well qualified. Every class of native 
 official is, according to western ideas, corrupt ; he 
 takes advantage of his position to exact his dues, 
 which we should call blackmail ; policemen for a 
 rupee will let anyone through a cordon, if it is safe 
 for him to do so ; an interview with an English official 
 of some standing may cost five rupees before the 
 scarlet and gold coated chaprasi will announce your 
 presence and business ; and even the native assistant- 
 surgeon, whom I succeeded in one district, a man of 
 good repute in the department, was driven about for 
 nothing and was fed by his disinfecting coolies. 
 
 So we go into partnership, the padre and I ; and 
 the result in a couple of months is 2500 inoculations, 
 with a maximum for one day of 350. Not very good ; 
 but not very bad considering that plague was only 
 sporadic in the district during those two months, 
 and that the people had to be persuaded into it in 
 nearly every instance. In India, as in England, it is 
 only a good rousing epidemic that will persuade 
 anyone, from statesman to peasant, to take action, 
 and often, alas, not even that. 
 
 Here is the kind of day we spend. We are out in 
 camp. The tents with other baggage have reached 
 their new destination on the backs of our six camels 
 and been pitched outside the town two or three hours, 
 before the padre and I jog in on our ponies, followed 
 by my inoculation-cart and professional suite. The 
 
() The Hakim or Doctor and his Dispensary in the Street. 
 
 (6) In the Lunatic Asylum at Lahore. 
 
 (A victim of Indian hemp ruler, he will tell you, of the asylum is linked with a madman always 
 on the grin, who becomes aggressive if you do not grin back. Behind them a Jogi, a wandering: 
 religious fanatic, who owns nine rubies, each equal to the treasury of eight kings. To the right, 
 the head-keeper. To the left, a veteran who killed his man thirty-four years ago, and whom, 
 
 though almost sane, they dare not discharge. 
 
THE PLAGUE-STRICKEN PUNJAB 17 
 
 headmen and elders of the village are there to receive 
 us, and one or two hold out a rupee on their open palm 
 for us to touch, and not to take away, as one of my 
 predecessors naively did last year to the old man's 
 considerable surprise. This village contains 2500 
 inhabitants ; it was attacked last year, they say ; 
 300 people died and only 5 of the 150 inoculated. 
 This year the people, they are sure, will come in 
 thousands to receive the wonderful medicine which 
 the kind-hearted government has so graciously sent 
 through these its most charming, honoured and 
 mighty officers. They will announce it through all 
 the village by beat of drum ; and do all they can to 
 induce their townsmen to be inoculated. Exeunt 
 all but the Christians, representing a much persecuted 
 little community of about fifty, whom the padre 
 arranged to visit at ten o'clock next day. The 
 descent close by of half-a-dozen kordn good shooting 
 and good eating closes the conference. Exeunt 
 padre and myself, guns on our shoulders, followed 
 by a motley and excited crowd. The sun sets and 
 we return after an hour to join the memsahib for 
 dinner ; but we avoid the subject of the birds. 
 
 The next morning, after an early breakfast, we 
 walk up to the village and find inoculation-apparatus 
 and staff all ready on the raised earth platform under 
 the big peepul-tree, with roots dripping from its 
 branches into the ground the common gossip-house 
 of the place. As spectators we have a few pot- 
 bellied brown urchins, clad in a pocket-handkerchief 
 each with a blue turquoise necklace and a steel ring 
 or two through the nose or ear. Chairs and light 
 
18 
 
 wooden bedsteads are brought, the headmen appear 
 and after a little brisk repartee between them and 
 the padre one of them brings his children and his 
 brother's children and his friend's children to be 
 inoculated. The padre goes off to preach. Munshi 
 squats in a corner, takes down particulars of each 
 person, and gives him the certificate to be signed 
 after inoculation (Plate 4). The compounder on 
 the moderately white tablecloth has a magazine 
 of little bottles in front of him, six full doses in 
 each, of Haffkine's prophylactic ; a growing cemetery 
 of the empty bottles ; an aluminium bowl of oil 
 in which he has sterilised half-a-dozen injection- 
 needles over a spirit lamp ; another bowl of carbolic 
 to hold the forceps with which from time to time 
 he opens a fresh bottle and puts it to my nose 
 for me to smell, before refilling one of the two 
 syringes which are kept in constant use. My 
 two chaprasis or messengers are hard at work 
 scrubbing the left arms just behind and below the 
 shoulder, one with soap and water, the other with 
 lysol, by means of lint held in clip-forceps. The lint, 
 it may be noted, requires very frequent changing. 
 Finally the clean patch of left arm, covered by a 
 patch of lint soaked in lysol, comes to the end of the 
 long row in which its owner has been squattingly 
 awaiting his turn and at last he passes me his certifi- 
 cate. I run my eye down the particulars. Unless 
 his health is marked good, I look at his tongue and 
 feel his pulse ; as it is most important for the credit 
 of the operation not to inoculate any with plague 
 already upon them, nor to produce an aggravation 
 
(fl) Inoculation against Plague. 
 
 The Munshi, a Mussulman, in the background, fills in the forms; 
 The chaprasi, a Hindu, on the right, scrubs the shoulders; 
 The cornpounder, a Sikh, in the centre, fills the syringe; 
 The doctor, an Englishman, drives the syringe home 
 The padre, from another world, takes the photograph. 
 
 (o) Boys in the School-yard await their turn. 
 
THE PLAGUE-STRICKEN PUNJAB 19 
 
 of any other existing fever. According to age I 
 decide the dose, one cubic centimetre at one year, 
 three at seven years, five at fifteen and upwards, and 
 adjust the stop-screw of the syringe accordingly. 
 " Dekho Look out ! ' And if the compounder has 
 sharpened the needle over night, it slips in and all is 
 over without trouble. If not, the victim makes a 
 grimace, and the onlookers, up to this point silent 
 in their breathless interest, break into a laugh and 
 a brisk exchange of wit follows. The compounder 
 writes the dose given on the certificate ; I add my 
 signature by rubber stamp ; and another inoculation 
 has been added to the roll. We do twenty in as many 
 minutes ; then there is a hitch ; then another twenty 
 and there is nobody left to do. Half-an-hour more 
 and the return of the inoculated to their homes 
 without serious damage has produced a few of their 
 relatives ; and then the stream begins and the work 
 goes on at full pace for an hour or two, accelerated 
 by the return of the padre after his preaching. A 
 score of women and infants are inoculated in a 
 separate compound with other women and infants 
 looking on from every neighbouring roof, cows and 
 buffalo mooing, donkeys braying, children squalling 
 and struggling a fine pandemonium. And last of 
 all come the sweepers ; no one will be done after the 
 sweepers ; it is the end. Half the inoculated have 
 been Christians, who have risen to a man ; the total 
 number is 120, and the headmen present their 
 books of testimonials and are quite upset when we 
 refuse to testify to their good works in assisting the 
 cause of inoculation. The thousands they promised 
 
20 HEALTH AND EMPIRE 
 
 would, they say, have come if any human inducement 
 could have had that effect ; they had undergone 
 untold trouble to induce the people ; but the people 
 were foolish. Had not all their own families been 
 inoculated ? They are warned that any outbreak 
 that may occur in the village will be due to their 
 failure to induce the greater part of the village to 
 be inoculated. The government will hold them 
 responsible. They must do better next time or it 
 will go ill with them. And so good-day. 
 
 Let us turn to another scene, where the syringe 
 invaded even the harem. In the south-east corner 
 of the Lahore district there is a town named Gharyala. 
 Passing through the town of Gharyala, where I in- 
 terviewed the officials six miles before my entry, we 
 came, my native staff of seven and myself, to Patti, 
 a largish town of 8000 inhabitants, where in the 
 previous year they lost 312 people from the plague, 
 only 26 being inoculated, of whom one got the plague 
 and none died. This is an out-of-the-way corner of 
 the district, seldom visited by European officials. 
 Nevertheless, my Sikh compounder, Achhar Singh, 
 a bright youth of nineteen, having galloped ahead 
 on his rough little pony, met me with the chief officials 
 outside the town and the welcome news that it con- 
 tained the finest rest-house we had yet met on our 
 tour. This had been erected in his own garden by 
 Mirza Mubarek Beg for sahibs on tour, and had 
 been furnished with walnut furniture, apparently 
 from Tottenham Court Road, and a piano made in 
 Bombay. It was six months since the rest-house 
 had been occupied, but there it was ready for use, a 
 
THE PLAGUE-STRICKEN PUNJAB 21 
 
 bungalow of considerable size, with every room 
 opening directly on to the verandah, well screened 
 from the heat of the sun, in the midst of Oriental 
 vegetation the word garden gives no idea under 
 the care of a native gardener and caretaker. After 
 exchanging the usual salaams and receiving the usual 
 assurances from Mubarek Beg that hundreds and 
 probably thousands would come on the morrow for 
 inoculation, and that his exertions would be, as they 
 had ever been, of incomparable effect in carrying out 
 the wishes of the government to that end, we re- 
 tired to the solitude of the bungalow. The next day 
 was a hard one. We were up at seven, and after 
 breakfast walked up into the city to inoculate the 
 whole of Umra and Shaja Beg's household, nineteen in 
 all, including the ladies in purdah. These were of the 
 family of Mubarek Beg, for the families lived together 
 in clan, and Mirza and all his family were anxious 
 to stand well with the government. 
 
 Mirza Shaja Beg, the son of Mubarek Beg, acted as 
 interpreter, having learned English at the Amritsar 
 school. It appeared that Umra was anxious to get the 
 vacant Zaildari or mayorship, which he declared was 
 promised him in succession to his father, who died 
 prematurely when Umra was still a lad. Umra, 
 after my visit to Patti, followed me for five days 
 round the country with a fine dali or present of fruit 
 and vegetables, and secured in return a direct note 
 to the deputy commissioner, who told me later, 
 however, that Umra was not the chosen man. 
 
 Inoculation, like charity, begins at home, and every 
 available arm should be produced in order to ac- 
 
22 HEALTH AND EMPIRE 
 
 centuate the merits of the Mirza's family. We 
 found our way by what seemed a small back entrance, 
 although in reality the chief entrance, into the rough 
 red-brick building red brick being of itself a mark 
 of distinction. A small room, twelve feet square, 
 with lattice windows looking out on to the slums on 
 one side, the balcony on the other, was given up to 
 the purpose. A deal table was with difficulty found 
 and stood in the middle of the room, with a couple 
 of European chairs, quite incongruous to the general 
 surroundings. My Indian staff, of course, could not 
 be allowed in the same room as the women of the 
 household. They therefore prepared the bottles and 
 basins, my clerk showed Shaja Beg how to fill in the 
 prescribed forms, and I was left alone with the 
 gentlemen of the household to inoculate first them- 
 selves and then their ladies. The ladies were brought 
 in one by one and dumped down at my side, 
 gazing at me through their peepholes. They were 
 covered, head and all, by dirty cotton shrouds, like 
 the furniture in a London house out of the season. 
 A slit had been made in the sheet behind the left 
 shoulder, and a square inch of brown flesh was 
 presented for the purposes of ablution and inocula- 
 tion. The opening having been extended a few inches 
 and the lysol vigorously applied, as was most neces- 
 sary, until the pinky-brown flesh appeared in its 
 native and beautiful tint, the inoculation was per- 
 formed in dead silence. There was something un- 
 canny in those black eyes watching intently every 
 detail of the operation from within a complete 
 fortress of white sheeting, without any other sign of 
 
THE PLAGUE-STRICKEN PUNJAB 23 
 
 life or feeling but the real flabby fleshiness of the left 
 arm. Umra Beg, husband, father, or master as the 
 case might be, was asked to address a few words in 
 explanation of the performance to moderate their 
 presumed anxieties, but in his opinion such fore- 
 thought was unnecessary, and certainly, in the event, 
 so far as all external manifestations of feeling were 
 concerned, one might have been inoculating a bolster. 
 The son and heir, however, evidently a spoiled young 
 rascal six or seven years of age, displayed no such 
 self-restraint a wild horse or infant in arms could not 
 have resisted more violently or shouted more lustily, 
 and the pandemonium that ensued, when the father, 
 the mother, the uncle, and a couple of servants 
 endeavoured to give the inoculator a chance, was 
 indescribable. Poor women, they were turned off 
 again into the prison-like desolation of the harem, 
 back to the life of the few yards of God's earth, the 
 dozen or so of God's creatures, that they are ever 
 destined to see on this side of the grave. " Salaam, 
 Sahib ! " said Umra Beg. " Salaam, Sahib ! " said 
 Shaja Beg. They had done their duty, and they 
 hoped that their efforts and my influence would 
 stand them in good stead when Mubarek retired from 
 his official position and one or other of them be- 
 sought the deputy commissioner to appoint him to the 
 vacant place. This was an end of inoculation at 
 Patti, for, although the drum was beaten round the 
 town incessantly, though the family Beg assured us 
 that they were doing their utmost to persuade the 
 people to follow their example, though the cloth was 
 spread over the inoculation table in a most tempting 
 
24 HEALTH AND EMPIRE 
 
 position on the verandah of the bungalow, not 
 another soul availed himself of the government's 
 munificence. 
 
 The fact is that inoculation had not and, it seems, 
 still has not as yet had fair play in the Punjab. 
 Compulsory measures being considered out of the 
 question, the inhabitants have been left merely the 
 option of adopting this new method of treatment or 
 refusing it. With their limited horizon of view, they 
 do not think of taking care for the morrow. They 
 wait till the plague comes, and comes in considerable 
 force. Then, like children, they are seized with 
 panic ; they apply to the government for aid, and 
 the government sends them the inoculator. But if 
 in England nearly half the children in the schools are 
 now unvaccinated, it is easily understood that in 
 India the vast majority object to inoculation against 
 the plague. Medicines they could understand, 
 charms and incantations they are used to, but a 
 prick with a needle gives definite pain, experience 
 shows that for two or three days afterwards, and 
 sometimes for more, the arm is almost useless, and 
 there is a general feeling of undoubted illness. How 
 can fatalists such as they be expected to realise the 
 eventual benefit of such an unpalatable method ? 
 It is only by such obvious instances as that of the 
 little village of Wirana already mentioned, it is only 
 where in the midst of death the inoculated are in life, 
 that the lesson is learned, if at all. And if there is 
 this difficulty for those of some understanding, the 
 difficulty with those who have none seems insuper- 
 able. 
 
THE PLAGUE-STRICKEN PUNJAB 25 
 
 In the early years of the plague epidemic, one of 
 the ablest of deputy commissioners made a tour 
 through his district, speaking of plague and its pre- 
 vention. On his second tour, in almost every village, 
 he found a fine temple erected to the Goddess of 
 Plague, the best temple by far in the place, and this 
 even in Mohammedan villages, where they believe 
 in only one God, but thought they might as well be 
 on the safe side. His method was to discuss fully 
 and freely the whole matter with them, to provoke 
 criticism and heckling in order to answer it. " Does 
 your Gospel," they would ask, " say all this about 
 the plague ? Because the Koran does not ! " His 
 answer would be ready : " You are perhaps a 
 cobbler : does the Koran tell you how to make a 
 pair of boots ? " Or again, the Hindu asks, " Do 
 you suppose angels trouble themselves with little 
 worms ? If they have decided to send the pestilence, 
 it is Kismet, and nothing that you can do will prevent 
 it." His answer again was ready : " Providence 
 sends you the harvest, but you must first sow the 
 seed. Providence sends bread through the seed of 
 corn ; Providence sends its pestilence through little 
 worms." Then there is the more revolutionary 
 objector : " Government does not really want to 
 save us ; it wants to poison us." The answer comes : 
 " If you have a good bullock which is ill, do you try 
 to poison it ? How will the government get its 
 revenue if thousands of taxpayers die ? " Some 
 there were, who were persuaded and believed. 
 After one of the discourses, half-a-dozen men came 
 the next morning, bearing in triumph an earthworm 
 
26 HEALTH AND EMPIRE 
 
 eight inches long : " Sahib, we have got the worm ! " 
 Education, was the conclusion of this officer, must be 
 the eventual and final preventive, but meanwhile 
 there should be more mild coercion than at present, 
 inter-communication between infected and unin- 
 fected villages should be stopped, and with this as 
 a lever privileges allowed to those who disinfect their 
 houses. 
 
 In inoculating such a series of cases, one cultivates 
 a habit of routine, and occasionally a detail may by 
 mistake be omitted. In one case, having carelessly 
 failed to screw down the buffer of the syringe which 
 limits the dose, I injected ten times the customary 
 dose into a young fellow, who, though strong and 
 only eighteen years of age, looked of delicate con- 
 stitution. Although there is little reason for believ- 
 ing that an overdose is poisonous, I was naturally 
 anxious for a whole month until the welcome news 
 came that at least no one at Patti was any the worse 
 for my visit. At Kasel by mistake we gave double 
 doses to about twenty persons, the dosage of the 
 bottles we were then using being discovered to our 
 dismay to be double the strength of the prophylactic 
 we had always used. This was on a Saturday, and 
 I was due at Mian Mir for the Sunday. The com- 
 pounder who was directly responsible for the over- 
 sight, and the young clerk, were made to stay there 
 overnight, and take the people's temperatures in 
 the morning, and again in the evening, but not one 
 was above 100*5, an< i mv assistants were accordingly 
 able to rejoin me on the Monday morning at Tarn- 
 Taran. 
 
THE PLAGUE-STRICKEN PUNJAB 27 
 
 Kasel was interesting in several ways. I visited 
 it with the civil surgeon under whom I was working, 
 a Lieutenant-Colonel in the Indian Medical Service, 
 whom I assisted to extract his ten thousandth cataract 
 from a man attracted by his fame from beyond the 
 Himalayas. We drove out the fourteen miles to 
 make inquiries . Lastyear5oo people were inoculated . 
 None of those inoculated got the plague, although 
 several others in the village died of it. This winter 
 the village had again been infected, so we made out, 
 through the visit of 5 Mohammedan and 2 other 
 inhabitants to the Id-Ghar at Amritsar, on the 
 Feast of Id (28th December) . All of them developed 
 plague within five days, and by igth January, the day 
 of our visit, there had been 74 cases, and already 
 34 deaths. Only one man, however, despite the 
 successful experience of inoculation in the previous 
 year, volunteered for inoculation. They were told 
 to let the civil surgeon know if more wished for it 
 or for disinfection. By the ist of February 126 
 cases had been reported, with 61 deaths. On 
 the I2th of March I met the Zaildar at a neigh- 
 bouring village, and he told me there had been 
 over 300. I decided therefore to try again, and 
 on the i gth of March paid a second visit to 
 Kasel. To show how difficult it is to secure any 
 information of the disease, we found in the registers 
 that as early as December, when, according to oral 
 information at our first visit, there had been no 
 deaths from plague, 22 people were said to have died 
 of fever, as compared with previous years, when only 
 two or three deaths would occur and those not from 
 
28 HEALTH AND EMPIRE 
 
 fever. This was obviously an early invasion of the 
 plague. With some difficulty we inoculated 43 
 persons. 
 
 At the village of Jauhal-Raju-Singh we inoculated 
 132 between four and six o'clock one evening. Four 
 days later, hearing that one of the inoculated was ill, 
 I bicycled over there, after a long day's work, the 
 roads appearing more impossible than ever, and 
 found plague rampant. Evidently, as usual, my 
 first inoculations had been made in a population 
 already terrified by prevalent disease. They were 
 anxious for my help on any lines, but the mischief for 
 the most part was already done. Escorted by the 
 local officials and fifteen or twenty of the population, 
 I paid a visit first to one house, then to another, and 
 so on to most of the wretched hovels infected through- 
 out the village. One would enter through a narrow 
 opening in one of the mud walls, flanking a three-foot 
 lane, into a squalid yard some twenty feet across, 
 six inches deep in mud, occupied by several goats, 
 two or three head of cattle, and two or three char- 
 payes, or plain native bedsteads, on which a few of 
 the worst cases had been brought out to die. They 
 lay in the last stages of fever, huddled up and dying 
 under the dirty padded bedclothes. The bedclothes 
 were removed, and one went through a certain 
 routine of medical examination, more by way of 
 form and excuse for passing the time than for any 
 other purpose. One passed on into the house, a mud 
 erection on the ground floor, with mud floor, mud 
 walls, a couple of doors open only for our benefit, 
 and a couple of tiny wooden-shuttered windows 
 
THE PLAGUE-STRICKEN PUNJAB 29 
 
 that evidently were seldom unbarred. In this dark, 
 dismal space, perhaps twenty feet long and ten wide, 
 were four dying patients on charpayes and two on 
 the floor, with half-a-dozen friends or relatives crouch- 
 ing by their side, wiping away the saliva from their 
 lips, and giving a little ghee, or sour whey. The 
 burden of responsibility was oppressive. What in- 
 deed was the value of our European rule and of all 
 our science, under such impossible conditions. To 
 say a few words of comfort ; to warn the attendants 
 against allowing the patients to move, under any 
 circumstances, for fear of heart failure ; to promise 
 a bottle of medicine next morning, knowing full well 
 it would be practically useless in any but the strongest 
 cases, this was all. The next day we returned and 
 inoculated 244 cases, taking as much care as possible 
 that those who were inoculated had not the disease 
 already upon them ; but there can be no doubt some 
 of them were already infected, and, when they are 
 already infected, the inoculation cannot overtake the 
 virus of the plague. In such cases, death after 
 inoculation may well appear to the native to be due 
 to the inoculation, and there are many who say it is 
 most unwise to have anything to do with a village 
 on which the plague has taken strong hold, for such 
 procedure brings discredit upon the operation and 
 deters other villages from applying for it in time. 
 But human sympathy is strong, and the conviction 
 that at Jauhal-Raju-Singh so many persons might 
 yet be saved by inoculation induced me to waive the 
 higher and probably more statesmanlike attitude of 
 refusal. The case is very like that of charity 
 
30 HEALTH AND EMPIRE 
 
 organisation at home. In cold blood we know 
 well that our half-crown will probably do as much 
 harm as good to the beggar who entreats help with 
 a piteous tale of misery and destitution, and yet 
 his tale or aspect gets the better of our conclusions, 
 and we may give him the money for better or 
 worse. 
 
 Two days later a special messenger sent over to 
 Jauhal-Raju-Singh found that three of those inocu- 
 lated had been attacked with fever and bubo on the 
 following day. "It is more important," said the 
 Chief Plague Medical Officer, who rode over and 
 found us at our work, " to avoid doing harm than to 
 do extra good " ; and the same applies to all prin- 
 ciples of Indian official administration. But the 
 novice in India knows little of such principles, and, 
 to the regret of those under whom he works, he 
 naturally does not give them a very full trial. For 
 treatment little can be done in the early stage a 
 fever mixture and an aperient ; in the later stage a 
 special plague mixture of strychnine and foxglove to 
 support the failing heart, with fomentations of oil or 
 ghee, to which we add a little carbolic, for the buboes. 
 In Hong-Kong very large doses of carbolic acid have 
 been given, apparently often with good effect ; but 
 carbolic is a strong poison, and it is difficult to ad- 
 minister a strong poison as medicine in an Indian 
 village visited only at intervals of some days or weeks, 
 without considerable danger of an overdose ; and if 
 your medicine obviously causes death, however you 
 may excuse yourself on the ground that it is your 
 patient's fault, the medicine and your treatment 
 
THE PLAGUE-STRICKEN PUNJAB 31 
 
 are entirely discredited, and future measures will 
 become impossible. 
 
 On 6th February, the padre and I, and Safedposh 
 (" White Cloak," a government decoration) Labh 
 Singh, rode over to Lalu Ghummen, at the request 
 of the villagers, and inoculated 108 persons, visited 
 4 plague cases, gave advice to about 12 other 
 patients, and found 6 deaths supposed to be due 
 to plague since zgih January. On nth March, I 
 happened to pass by the same village, and found it 
 practically deserted. There had been since the end 
 of Januaty go deaths, and probably others in 
 neighbouring villages to which they had fled. Of the 
 108 inoculated, 3 died ; i woman within three 
 days ; i boy of five, who had high fever within 
 twenty-four hours and died with a bubo on the fifth 
 day ; and i girl of twenty, who became ill after 
 two weeks with a bubo in either groin, followed by a 
 bubo on either side of the neck and resulting in death 
 four weeks after inoculation. The two first cases had 
 evidently the infection of plague upon them at the 
 time of inoculation ; the third died, despite inocula- 
 tion, with an exceptionally severe attack of the 
 disease. For it must be remembered that the human 
 frame and constitution vary in their susceptibility to 
 any one disease ; that a dose of prophylactic, which 
 is sufficient for the average person, is bound to be 
 insufficient for those who are very susceptible ; while 
 the average dose, again, is quite superfluous for many 
 who are comparatively immune to that disease. 
 No system can ever secure all members of the com- 
 munity against the disease until we have what at 
 
32 HEALTH AND EMPIRE 
 
 present we have not some test of their relative 
 immunity or susceptibility. The experience there- 
 fore of Lalu Ghummen is about as favourable a proof 
 of the value of inoculation against plague as it is 
 possible to conceive. Had the first two who died 
 been inoculated, as the government wished all to be 
 inoculated, before the approach of the epidemic, 
 presumably only one of all those inoculated would 
 have died. Nevertheless, of the few inhabitants 
 left, those who had not already been inoculated re- 
 fused inoculation on the score of those three deaths, 
 at least, so said the Lambardars, the lesser govern- 
 ment officials, on whom we had to depend for informa- 
 tion or assistance. 
 
 It was often difficult to know whether the refusal 
 of inoculation was due to the reasons given, to mere 
 distrust of government measures, or simply to 
 apathetic resignation. In Daftu the inhabitants were 
 celebrating three weddings, and could not be gathered 
 together for my purposes. Word was sent them that 
 they should apply for my assistance if they wished 
 it two days later, but that I could not spare time to 
 come unless at least fifty wished to be treated. This 
 may seem callous, but when one official has to con- 
 sider the interests of over a million persons, he must 
 be sure that the visits he arranges to make are worth 
 the time spent upon them. The next two villages 
 visited were Mohammedan, and much inoculation 
 was done there in the previous year. I arrived there 
 before they had been attacked this season, but they 
 were keeping the Feast of Rosa, or Ramzan, during 
 which the pious Mohammedan may not drink in the 
 
THE PLAGUE-STRICKEN PUNJAB 33 
 
 daytime. From this, the argument branched off in 
 two directions. On the one hand, it said that their 
 law forbade them to take any substance, whether 
 food or drug, into their person ; on the other hand, 
 it declared although we did not that after inocula- 
 tion you must drink milk, and they could not drink 
 milk during the day. Night work is an impossibility 
 under such circumstances, and so inoculation was 
 deferred for eleven days, and eventually was not 
 performed at all. The duty of the local officials 
 for as duty they all seemed to consider their attention 
 to my mission was completed by the presentation 
 of two cauliflowers, twenty oranges, a pound of 
 almonds, and two dozen stodgy sweetmeats of almond 
 paste and raisins, the scattering of which secured me 
 a temporary popularity amongst the crowd. 
 
 An assistant surgeon came into my bungalow at 
 Kasur, and stayed for a long chat. He said that 
 Ramzan was quite a sufficient reason against Moham- 
 medans being inoculated, for they would not take 
 anything between their teeth, or even have their 
 ears syringed out, between five o'clock in the morning 
 and half-past five at night. He considered that, 
 with a little pressure, the people would flock to be 
 inoculated, when, but only when, the plague was at 
 their doors. He thought a good poster, a circular 
 to the local officials, and a lantern lecture by a sahib, 
 would all help much to make the people understand 
 the value of the new method ; but the people refused 
 to believe in the germ theory even after hearing all 
 about it, and the arguments must necessarily there- 
 fore be based on experience. He did not consider 
 
34 HEALTH AND EMPIRE 
 
 that trade between towns, dealing as it did with 
 markets direct, spread the plague, which was mainly 
 diffused in his opinion by women who go to mourn at 
 funerals, and who by custom lie on the bed with the 
 patient up to, and even after, death, and on the 
 following night always lie on the bare earth. It was 
 for this reason, he considered, that plague was 
 commoner in women than in men. But he admitted, 
 rather unwillingly, that this difference between the 
 sexes might be due to the transmission of the disease 
 through fleas, since the women are dirtier, and stay 
 more at home ; they are more ignorant and careless 
 about infection ; and, moreover, it was recognised 
 that rats, formerly plentiful, were absent during the 
 plague in these villages, having all died or migrated 
 and, according to the flea theory, left their fleas 
 to find their food on less palatable man. He gave 
 an interesting instance of the value of inoculation 
 in Kesel Gurh in the previous year, when ninety per 
 cent, of the population were inoculated. Twenty 
 of these had plague, and none died, while of the 
 remaining ten per cent, nine had the plague, and six 
 died. 
 
 Plague having devastated the Punjab to an in- 
 creasing extent from 1894 onwards, the Punjab 
 Government decided in 1902 to undertake an exten- 
 sive scheme of inoculation, devised both in principle 
 and detail by one of their medical officers, afterwards 
 Major Wilkinson, Chief Plague Medical Officer of the 
 Punjab. It was hoped to inoculate a very large 
 proportion of the population in the autumn, in 
 advance of the annual invasion of the plague, which 
 
THE PLAGUE-STRICKEN PUNJAB 35 
 
 commences a little before the New Year. Their 
 ordinary medical officers were obviously too well 
 engaged in their other duties to be able to spare time 
 for such an extensive measure. They engaged there- 
 fore upwards of fifty young doctors of high pro- 
 fessional quality from the London medical schools, 
 at a remuneration sufficient to ensure a selection of 
 that ability which they considered essential to 
 the success of their scheme. This learned expedition 
 has passed unnoticed, but it is one of many instances, 
 unique and unprecedented in the world's history, of 
 experiments made in the development of our empire. 
 These pioneers arrived in September 1902, and for 
 some weeks were expected to do little but accustom 
 themselves to Indian ways of life and administration. 
 For every one of them a particular sphere of work 
 was mapped out, a staff of ample proportions was 
 engaged, and tents and equipment were prepared 
 on a liberal scale. It was a new experiment, and the 
 machine was with some difficulty set to work. Some 
 men were unsuited to the climate ; some, despite 
 professional ability, entirely unsuited to the work ; 
 and long before the experiment was in full swing a 
 melancholy disaster occurred which shattered the 
 whole scheme. 
 
 In a small village named Mulkowal the inoculating 
 officer, whom no one could impugn either on the score 
 of professional ability or sense of responsibility and 
 tact, awaited for six hours, with all his apparatus 
 prepared, the return of the villagers from the fields, 
 to which they had fled on his approach. Eighteen 
 persons were inoculated at Mulkowal and one at 
 
36 HEALTH AND EMPIRE 
 
 Ferozpore, all from the same bottle. Every one of 
 these cases died of lockjaw or tetanus. This bottle 
 was only one out of a large brew which had left the 
 laboratory at Parel, outside Bombay, four weeks 
 previously. The others caused no tetanus ; therefore 
 the infection was one not of the brew but of the bottle. 
 The question was whether the bottle was infected on 
 the spot or at the time of bottling at Parel four weeks 
 before. The answer depended on expert bacterial 
 examination of the particular bottle concerned. A 
 commission of three was appointed to inquire into 
 the whole matter ; they concluded that the con- 
 tamination occurred at Parel. The question was 
 referred, however, to the Lister Institute in London 
 and they, after further experiments, first concurred 
 and then threw doubt on this finding. Mr. Haffkine 
 finally appealed to the home government in an 
 exhaustive review of the case ; and a letter to The 
 Times from ten leading authorities in Great Britain 
 and the United States showed that Mr. Harfkine had 
 proved his point. Contamination occurred at Mul- 
 kowal. 
 
 The Indian government, however, had to justify 
 itself to the people and it seized on the methods in 
 use at Parel. It appeared that, a few months before 
 the occurrence of the Mulkowal incident, Mr. Haffkine 
 had for good reason introduced a change in his method 
 of preparing the prophylactic. The modification was 
 based on an analogy with his cholera experiments 
 and on the experience of the Pasteur Institute in 
 Paris, but it opened the way to ten times as many 
 chances of pollution. The government discovered 
 
THE PLAGUE-STRICKEN PUNJAB 37 
 
 that this change had been made, and concluded that 
 it might have been responsible for the whole trouble. 
 They ordered a return to the former methods, and, 
 when a sufficient supply of prophylactic, produced 
 on the old lines and tested by more stringent tests 
 than ever, was ready, they were in a position to 
 announce to the natives of the Punjab that recourse 
 could be had, with perfect safety and great advantage 
 to themselves, to the operation for inoculation. The 
 government entirely exonerated the inoculating 
 officer from any responsibility for the infection ; 
 they dispensed with the services of Mr. Haffkine. 
 
 It was a lamentable fiasco. Of all the vast supply 
 of prophylactic prepared in advance up to that date 
 at Parel, so long as the question of infection at Parel 
 was still undecided, not one bottle could be used, 
 and in the event it was all destroyed. No further 
 inoculation could be performed until a safe supply of 
 prophylactic could be guaranteed, and by that time 
 it had become spread throughout the length and 
 breadth of the Punjab that nineteen persons had 
 been poisoned by the government's measures. 
 
 To continue inoculation under such circumstances, 
 at least with any show of pressure, was clearly im- 
 possible ; the government could only fall back on 
 their former attitude of offering assistance where it 
 was asked for. There are some who think it would 
 have been well if the government, so soon as the 
 safety of the Parel prophylactic was ascertained, had 
 continued their scheme of inoculation as if nothing 
 had happened, using as much official pressure as 
 possible, relaxing it only when the popular feeling 
 
88 HEALTH AND EMPIRE 
 
 against it rose to a dangerous extent. But such is 
 not the principle of the Punjab government, nor 
 indeed of the Indian administration in any depart- 
 ment. It is considered the best course to let the 
 people, by slow degrees and by constant affliction, 
 learn their lesson and come to a fatherly govern- 
 ment willingly for help, than that they should be 
 coerced into submission to measures which at first 
 appearance often seem to them worse than the 
 disease. It must be at the same time noted that 
 compulsory measures lead to concealment of cases, 
 and so to uncontrolled spread of the disease. The 
 flaw in this argument is that the people do not learn 
 the lesson but continue to die in increasing numbers. 
 
 The year after the Mulkowal incident I was touring 
 round the villages of the Lahore and Amritsar dis- 
 tricts, and found, in so far as it is possible to arrive 
 at the convictions of the Indian people on any 
 subject, that the fact of the Mulkowal incident 
 rankled in their breasts, and was a very real and 
 probably the chief obstacle to inoculation ; and I am 
 bound to admit that I was not wholly without anxiety 
 myself perfectly unreasonable anxiety, no doubt- 
 when the padre and I subjected ourselves to inocula- 
 tion for an example, and at least professedly as a 
 security in our work, in the Gate of the Golden 
 Temple of Tarn-Taran. 
 
 This year the government had decided to apply 
 no pressure, and so, instead of the fifty inoculation 
 officers, there were now only six such special officers 
 retained, to whose number I was privileged to be 
 added as a seventh. It was our duty to go round the 
 
THE PLAGUE-STRICKEN PUNJAB 39 
 
 villages, preaching, through the medium of our 
 munshis, the history of recent outbreaks of the 
 plague, the almost certainty of its recurrence in 
 increasing virulence, and the measures which the 
 government suggested to guard against it. You 
 may prevent disease in the individual, but it is 
 obviously far more effective to prevent it in bulk ; 
 and however great the claims of inoculation to 
 guarantee the safety of the individual may be, there 
 seemed no doubt that infinitely the most effective 
 method of combating the plague was by prompt 
 evacuation of an infected village. The inhabitants, 
 however, could not be left to find their lodging in 
 other villages, for so they would only spread the 
 plague more widely. As with our city improvement 
 schemes at home, accommodation must be found 
 for a displaced population ; and this accommodation 
 would in general be found by the erection, at some 
 little distance from the village, of mat sheds, or other 
 temporary houses, into which the whole population 
 were bound to move, and within which they were to 
 be confined for a certain period until plague was at 
 an end in their midst. In some parts, for instance, 
 of the United Provinces this method had been most 
 effective, but in the Punjab the first difficulty arose 
 in the reluctance of the natives to leave their homes 
 at any cost, and in the supposed insecurity of their 
 possessions and valuables in the new encampment. 
 The second difficulty lay in deciding who should pay 
 for the cost of removal. The answer of the Punjab 
 government was distinct, that the expense must be 
 borne by the locality ; and although in other parts 
 
40 HEALTH AND EMPIRE 
 
 localities had agreed to bear this expense, and had 
 succeeded almost invariably thereby in stamping out 
 the plague, in our own districts not a single village 
 was prepared to fall in with this suggestion. 
 
 Inoculation then was practically useless to the 
 community for what are 2500 inoculated persons 
 amongst so many ? Evacuation was refused. There 
 remained only one suggestion, the makeshift of dis- 
 infection. Of this I had but one experience. A 
 wire came to me on 20th December, out in a distant 
 village " Plague broken out Changa Manga. Go 
 there immediately." I arrived in advance of my 
 staff and equipment, and spent the night with the 
 native forester. A hospital assistant arrived next 
 morning, and set his men hard at work removing, 
 with the help of the inhabitants, the furniture 
 from their infected huts, brushing down the walls 
 with chemicals and washing out the floor (Plate 5). 
 But the people dry the floor afterwards by putting 
 fresh dry earth, which may itself be infected, upon 
 it, and sleep on it themselves with clothes not dis- 
 infected. Such a thing as a full-length bath is un- 
 known, and, if we had one, it would be impossible 
 to use it. The first improvement to make was at 
 least to suggest a wash and the disinfection of clothes ; 
 the second to disinfect, not by chemicals but by heat. 
 Whether conveyed solely by fleas or not, there was 
 no doubt that the infection came largely from direct 
 contact with the earth. Of these ten disinfecting 
 coolies only one had had the plague ; but they had 
 all been made to wear leather boots and leggings. 
 The one exception was found to have objected to his 
 
Disinfection Out in the Forest. 
 
 Coolies at work inside, while tenants, their wives, cattle and other possessions bask in the 
 sun outside. A sweeper's wife in the far corner is dying. 
 
THE PLAGUE-STRICKEN PUNJAB 41 
 
 boots and leggings, and to have been in the habit of 
 removing them. It was only this year that they 
 had taken to thus protecting their feet ; formerly 
 their predecessors had suffered most severely from 
 plague. But chemical disinfection by fluids is use- 
 less enough in England ; it is quite useless in India 
 as performed in mud huts by the Indian native. It 
 is also very expensive ; and a far better method is 
 desiccation, or disinfection by heat. 
 
 My compounder brought a stove for this purpose 
 a cheap affair of thin iron, in which we burned wood 
 and banana-tops, and anything else handy ; and we 
 started with this to disinfect the infected row of 
 sixteen back-to-back huts. All contents had been 
 turned out into the sun in itself a good disinfectant. 
 The walls were still painted green with the chemical 
 up to a height of six feet. The colour at least gave 
 confidence and a check on the work done. The 
 floors were scraped, and an inch of earth carted away 
 to the forest. The contents of the hut were now 
 packed inside a close fit when room had to be made 
 for the stove in the centre of the floor. The little 
 chimney in the roof was stopped up, cracks and doors 
 were closed, and an hour and a half passed before the 
 iron bolts of the door, by their uncomfortable heat, 
 showed that a sufficient temperature was reached 
 inside for disinfection to be considered to have 
 begun. Meanwhile the second and the third huts 
 were packed up again with their ventilated sun-dried 
 contents, ready for the use of the stove when the 
 first hut was finished. It was a long business, and 
 to disinfect seven huts in a day was good work. 
 
42 HEALTH AND EMPIRE 
 
 Even so, the process was not perfect. We had no 
 clean spare garments with which the poor people 
 might cover themselves while waiting after a bath 
 for their clothes to be heated in the next house. In 
 the second place, when it came to a sweeper's house, 
 the Mohammedan women who were their neigh- 
 bours would not admit any of the sweepers' things 
 for disinfection into their own houses, and they 
 obviously could not use their houses both for bathing 
 and disinfection at the same time. In the third place, 
 they all object to washing, especially in carbolic, 
 because it smells. And, fourthly, the paint on their 
 gaudy furniture is liable to suffer. Nevertheless, 
 the process is accompanied with perhaps less dis- 
 comfort than any other system adopted by the 
 Government, and it had the additional and very 
 considerable recommendation that it left the huts 
 hot and dry. 
 
 At the end of a winter's work one feels fairly well 
 in despair as to the whole business ; seven years later 
 the despair is confirmed. 
 
 The death-rate from plague in 1904 in the Lahore 
 and Amritsar districts in which I worked was 25 
 per 1000. Over 1,000,000 Indians died of plague in 
 1904, over 1,000,000 in 1905 ; in 1906, 332,000 and 
 it was thought the end was in sight. But 640,000 
 died in the first four months of 1907 ; in 1908, 
 321,000 died ; in 1909 only 175,000, but in 1910 
 again very nearly 500,000, and this year more than 
 ever. The United Provinces had barely been 
 reached by the epidemic in 1904 ; now with a popu- 
 lation equal to that of the United Kingdom they have 
 
THE PLAGUE-STRICKEN PUNJAB 43 
 
 been losing 20,000 every week; and the Punjab 
 34,000 in one week, 39,000, 47,000, 54,000, 60,000, 
 and so on, over 430,000 in the first four months of 
 this year in a population of 25,000,000. Imagine 
 Great Britain and Ireland losing the same proportion 
 over 1,000,000 from plague in half a year. And 
 India as a whole has in fifteen years lost over 
 7,000,000 from plague. Why wonder at her un- 
 rest ! 
 
 What then can the government do ? The only 
 complete scheme has been killed by the Mulkowal 
 incident ; extermination of rats is impossible ; disin- 
 fection on a large scale is impracticable ; evacuation 
 of villages cannot be done voluntarily on any universal 
 scale ; the government will not apply compulsion, and 
 such evacuation is quite useless without a rigid cordon 
 of police or military that will prevent communication 
 between one infected village and others not yet in- 
 fected. A cordon, it has been proved over and 
 over again, cannot be maintained; the native who 
 wishes to pass it has only to present some official 
 with a cautious rupee. Extermination of rats in an 
 Asiatic country has often failed ; but here is with- 
 out a shadow of doubt the key to the problem. The 
 methods formerly adopted had been to give a capita- 
 tion grant for every rat brought to the appointed 
 place, and before long it was found, for instance in 
 Bombay, that an extensive trade had grown up in 
 the breeding of rats, whereby, at a few annas apiece 
 from the government, many families were able to 
 sustain a comfortable existence. The same thing 
 was once done with regard to poisonous snakes ; a 
 
44 HEALTH AND EMPIRE 
 
 breeding-farm of extensive proportions was dis- 
 covered in full operation in order to take benefit of 
 the government grant. But since sentence on the 
 rat-flea has been pronounced for the murder of 
 7,000,000 persons and over, the best method for his 
 extermination will not be far off. Sulphur is coming 
 again into favour and we are reminded that both in 
 Rome and in Mesopotamia non-poisonous snakes were 
 kept, it is believed, for this purpose. Cats, however, 
 are useless as they may themselves take the plague. 
 In any cases total extermination is improbable. 
 
 It is often debated whether even half-measures are 
 worth being continued. Professor W. J. Simpson, in 
 his exhaustive monograph on the plague and in 
 1907 in his Croonian Lectures, has shown how in 
 history epidemics of plague have come and gone in 
 different countries with long intervals between 
 them, often of one hundred and thirty to one 
 hundred and fifty years. In the eighteenth century, 
 for instance, India seems to have been almost 
 free of the plague, but early in the seventeenth 
 century it suffered severely. The present epidemic 
 is assuming, as for as we can trust previous records, 
 unprecedented proportions ; probably after a few 
 years it will die out again. An occasional cynic may 
 argue that, since we have saved so many thousands 
 of lives annually from famine and from wars, it 
 may be just as well to let the plague take their place. 
 To such a pessimistic and inhuman conclusion it is 
 impossible for one moment to submit. It may be 
 that for economic reasons some parts of the Indian 
 Empire would be happier if their population were 
 
THE PLAGUE-STRICKEN PUNJAB 45 
 
 less dense ; but it does not follow that we should 
 allow death to stalk uninterrupted, unopposed, and 
 apparently without limit, throughout the country. 
 Economics apart, we may yet be absolutely con- 
 vinced, whether as doctors or as statesmen, that it 
 is our mission, our duty, to protect the populations 
 included under British rule to the best of our ability 
 against every scourge as it may arise ; and there- 
 fore it is urgent that such measures as we have be 
 pushed forward with the utmost vigour. We cannot 
 aim in this world at perfection ; we must often be 
 content with half-measures, and it is through half- 
 measures that we often find the clue to complete 
 control of the situation. But those half -measures 
 must be adopted vigorously and in earnest ; and it 
 would seem a very considerable mistake that such 
 effective measures as evacuation of a complete 
 population should have to depend entirely upon local 
 funds. If anything is to be supported by the general 
 exchequer, whether of the provinces or the government 
 of India, surely it is measures for the prevention, cur- 
 tailment and stamping out of so terrible an epidemic. 
 A practical policy is urgently needed, and this 
 practical policy might with advantage, to my mind, 
 go a little further in the direction of compulsion than 
 the Punjab government have lately been inclined to 
 go. In the winter with which this chapter deals, 
 the only duty of the local officials in the matter of 
 plague was to notify the first five cases that occurred 
 to the deputy commissioner and the civil surgeon 
 of their district, and this duty, intended as at least 
 a warning of the incidence of the disease, was neg- 
 
46 HEALTH AND EMPIRE 
 
 lected far and wide. The Mulkowal incident, a mere 
 fly in the ointment, paralysed the Indian govern- 
 ment, and the Plague Commission which reported in 
 1903 gave them little security or certainty as a basis 
 for adopting any strong policy. As an instance 
 might be noted the conclusions of the Plague Com- 
 mission, that whereas, in an extensive system of 
 examination of travellers at railway stations through- 
 out the Indian Empire, very few cases of plague had 
 been detected, all trammels on railway intercom- 
 munication should be suspended. But in point 
 of fact this measure had indirectly limited com- 
 munication, by deterring plague patients from 
 travelling, and so to a very considerable extent pre- 
 venting the dissemination of the disease. The rules 
 were relaxed, and already, within a few months before 
 I had left India, there was evidence to show that 
 plague had broken out in certain villages to which it 
 was previously unknown ; whereas in a few adjoining 
 districts, where railway inspection still continued, 
 plague was as yet unknown. 
 
 Education of the people is certainly the bedrock 
 of all progress ; whether in schools or in the Press 
 or by leaflets, posters, lantern slides and lectures. 
 Little if anything was being done in this way in 1904 
 with a view to the arrest of the plague just a 
 memorandum issued to village authorities every 
 now and then. But to educate, the government 
 must have a method and a policy. 
 
 Whatever be the best method to adopt, there can 
 be no doubt that in India we have an enormous field 
 of research, of which insufficient use has hitherto 
 
THE PLAGUE-STRICKEN PUNJAB 47 
 
 been made. India has now established a Central 
 Research Laboratory in each province, and will 
 doubtless get much good work out of the distinguished 
 officers there engaged. But there is need for a 
 definite and permanent organisation to investigate 
 the subject of epidemics in all parts of the empire, 
 both in their scientific and administrative aspects. 
 To some extent the late Lieut. -Col. Leslie, who in 
 1904 was appointed Sanitary Commissioner to the 
 Government of India, was doing this for India in 
 addition to his innumerable other duties and anxi- 
 eties ; many other members of the service, in their 
 several vacations and callings, are engaged in the 
 same pursuit ; our home government has appointed 
 another commission on more scientific lines to shut 
 the stable-door after the horse has bolted ; and there 
 have been many commissions, of many European 
 countries besides our own, which have investigated 
 the plague without as yet having found the final 
 clue to its prevention and extermination. But for 
 a study of this sort, and for practical measures which 
 shall be of use to us throughout the empire, we again 
 feel the need, which will be referred to frequently in 
 this book, of an imperial conception of preventive 
 medicine, and of an imperial organisation to study 
 the causes of epidemic disease and to inaugurate 
 measures to cope with it. The empire needs a 
 general staff for disease as much as for war. So 
 long as we go on nibbling at the cherry, it will always 
 elude us ; so long as we appoint occasional com- 
 missions and occasional officials, with a multitude of 
 other duties on their hands, to deal with the question 
 
48 HEALTH AND EMPIRE 
 
 of one epidemic in one country at one particular time 
 with that epidemic at its height, the question will 
 never be settled. A large well-endowed imperial 
 organisation, with the powers and responsibilities of 
 the War Office or the Admiralty, would undertake 
 the question with a proper sense of proportion ; and, 
 if the government were determined with their assist- 
 ance to find some way out of the present difficulties, 
 I am convinced that such a body would find it, for 
 the direct benefit of India, and the indirect benefit of 
 science and the whole world. 
 
 The commission appointed four years ago, now 
 called an advisory board, is still at work, and has 
 done good work too. But it was a bacteriological 
 commission, which has spent all its time in proving 
 to the hilt the truth of the rat-flea theory of the 
 transmission of bubonic plague, as put forward by 
 M. Simond of the Pasteur Institute in 1898 and proved 
 at least to my satisfaction by Capt. Liston in 1903. 
 This did not require such complete verification ; and 
 no time appears to have been yet spent in the far 
 more important questions as to other possible means 
 of infection. 
 
 The mistake made is in the nature and purposes 
 of the commission. What is required is to discover 
 practical measures for the arrest of plague. The 
 present medical staff has its hands full. A special 
 sanitary staff is essential and a considerable ex- 
 penditure will have to be incurred. The creation of 
 such a staff, its duties and its methods, require the 
 most careful consideration. 
 
 A small but strong and independent commission 
 
DISPOSAL OF SEWAGE. 
 
 (n) Bullock-Cart for Removal of Slops. 
 (6) New Septic Tank for Simla. 
 
 Southward from May-Day Hill. 
 
 (looft. x 9 X 9} deep ; from which effluent falls by tippers and perforated trays on to bacterial 
 filter of small granite at the side, 48ft. x 18 x 8, not here shown.) 
 
WATER SUPPLY. 
 
 (a) A Roadside Well by Dehli. 
 
 One yoke of oxen have mounted the inclined way, ready for the next pull, while another yoke on 
 their way down have pulled up the leather mussak, full of water, to the brim. 
 
 (6) A Persian Wheel in Lahore. 
 
 Within mud wall the unmuzzled, blinkered oxen tread their endless round. And nothing sings of 
 India like the rhythmic moan and creaking of the wooden wheel. 
 
THE PLAGUE-STRICKEN PUNJAB 49 
 
 should now be appointed of lay and medical men, 
 experienced in sanitary administration, to build on 
 the foundations laid for them by the present scientific 
 commission and to draw up a practical scheme to 
 deal with the plague. The result would probably 
 be the establishment of a permanent sanitary service 
 of untold benefit directly and indirectly to the Indian 
 people. 
 
 FOOTNOTE ON SANITATION 
 
 Work specifically against the plague did not exclude, it offered 
 many facilities for, attention to matters of common sanitation. 
 The many notes made on these subjects, while not shaping them- 
 selves for a chapter in this book, may be represented by the ac- 
 companying Plates 6 and 7. 
 
 In the natural conditions of Indian life, heat, light and a 
 porous soil disarm and dispose naturally of excrement, when 
 deposited, as of wont, on open ground. But in village streets, 
 in shaded courtyards and in towns filth accumulates ; and there 
 is need for the development of a sanitary service. Europeans use 
 pail closets, emptied without delay by the " sweepers " ; at the 
 club in Lahore slops were removed by bullock-cart. At Simla 
 an installation was just completed for bacterial treatment, and 
 it would be of interest to know how far the climatic conditions 
 modify or facilitate as one would expect the septic treatment. 
 
 Water-supply must be of the first importance in tropical 
 countries where water-borne diseases, dysentery, cholera and 
 enteric fever are rife, and often devastating in effect. Pains are 
 taken by administrators to secure the surface wells in every 
 village from chance pollution ; but the chances of pollution are 
 still obvious. The picturesque method of raising water by 
 bullocks and the Persian wheel is common ; distribution takes 
 place with rare exceptions by hand ; but water schemes are 
 being gradually adopted for the towns. 
 
CHAPTER II 
 
 BRITISH RULE AND THE GAMBLE IN LIFE 
 
 " As to British Rule, our Government gives security 
 for life and justice ; but do the natives care for 
 security ? They prefer far more the chance of 
 becoming Vizier one day and being beheaded the 
 next. Under our system they miss their gamble in 
 life." 
 
 We were dining under electric punkahs in a 
 Calcutta hotel on the conclusion of my Indian work. 
 The speaker was a Parsi lady of quality, singularly 
 qualified to understand and estimate the methods 
 and aims of British rule. We were old friends from 
 Oxford days. Her father, an early convert to 
 Christianity, has done sterling work as an Anglican 
 priest. Both she and her brother read law at 
 Oxford and took high degrees. Her brother was 
 now practising as a barrister in Allahabad, lecturing 
 at the college, and bearing the cross in front of the 
 bishop at church festivals, while this Indian Portia, 
 convinced that the Indian people were only waiting 
 for a leader to adopt Christianity, with a softened 
 dogma, wholesale, was intent on protecting the legal 
 rights of Indian women. 
 
 The backward state of female education in India 
 and the early age of marriage are proverbial, and 
 
 5 
 
THE GAMBLE IN LIFE 51 
 
 widows of property, unable to bear witness in court 
 except in purdah surrounded by their suite, will often 
 be induced by designing native gentry to sign away 
 their property through ignorance, on blank forms. 
 Portia's scheme proposed that a female official 
 trained in the law should be attached to each 
 High Court to take female evidence on commission. 
 A recent visit to England and sympathetic inter- 
 views at the India Office induced her to believe her 
 scheme would succeed. 
 
 But the great interest due to her scheme was over- 
 shadowed by her suggestion as to " the gamble in 
 life." It was one of those staggering bouleverse- 
 ments that constitute the charm and value of world- 
 wide travel. Peace and justice, deliverance from 
 plague and famine, education according to European 
 rules, typify the prime ideals of British government. 
 Can they ever be unsound ? Are they calculated to 
 make the natives happier, or to fit the country to 
 compete for survival amongst the predominant races 
 of the world ? Or is their suitability to India taken 
 for granted and may the presumption be sometimes 
 carried too far ? 
 
 It would seem that by degrees we are changing 
 our ideas as to the government of dependent races. 
 Lord Curzon's and Lord Minto's viceroyalties have 
 coincided with a very marked effort to assist the 
 better forms of native aspiration, as for instance in 
 the restoration and upkeep of the Taj at Agra, and 
 religious buildings throughout India ; in the develop- 
 ment of native industry ; in the development of 
 native political responsibility and in the higher 
 
52 HEALTH AND EMPIRE 
 
 education of native rulers. The Cambridge con- 
 temporary with whom I travelled out to India, once 
 a prominent member of the old Corinthian football 
 team, had been for six years guardian one can 
 hardly say tutor to the young Nawab of Bhawal- 
 >ur. The Nawab ranks as second only to the Nizam 
 of Hyderabad of all the Mohammedan chiefs in 
 India, and eighth of all Indian native rulers. His 
 tutor's conception of the education required was 
 that befitting an English country gentleman, based 
 on a love of sport and of physical fatigue. The 
 Nawab 's minority was at an end, and a few weeks 
 later Lord Curzon installed him as the responsible 
 Governor of his native state. The fear in such a case 
 must ever be lest the privileges of luxury inseparable 
 from native rule get soon the better of the few 
 years' athletic and healthy training. But the train- 
 ing is evidently on the right lines, and the develop- 
 ment of the colleges for native chiefs, under Lord 
 Curzon's vigorous and sympathetic control, was a 
 further step in the same direction. In the Aitcheson 
 College at Lahore, for instance, under the presidency 
 of a retired colonel, young native chiefs or junior 
 members of a ruling family were now quartered with 
 their suites within the ample grounds of the institu- 
 tion. Horsemanship was the basis of their athletic 
 education ; for few people will deny that the qualities 
 required for the good polo-player or steeplechase- 
 rider are essential to vigorous rule ; and it is essen- 
 tially the vigour of government which native rulers 
 lack. The privileges, the pomp and circumstance, 
 the luxury of rulers, are manifest ; shrewdness is not 
 
THE GAMBLE IN LIFE 53 
 
 uncommon ; but vigorous initiative and firm control 
 are lamentably wanting. The defect is historic. 
 Indeed, it was largely owing to the lack of any com- 
 petent native leader that the Mutiny was suppressed ; 
 for a capable leader, it can hardly be doubted, would 
 have driven the besiegers off the ridge at Dehli, and 
 the conquest of India would have had to have been 
 begun over again. Under modern safeguards, there- 
 fore, it is essential for native rule that vigour and 
 individual character shall be stimulated amongst the 
 native chiefs in early life. This will give to Indian 
 administration some of the more fascinating and 
 stimulating qualities to which my Portia refers as 
 " the gamble in life " the chance of a beggar being 
 selected, without examination, for official approval 
 while guarding against any return of those scenes of 
 atrocity which would now, at least, after a long 
 period of British rule, be both inconceivable and 
 cruel. 
 
 The idea of " the gamble in life " is suggestive 
 when we pride ourselves on the virtues of British 
 rule. An eminent medical man in the Malay States, 
 a few weeks later in my travel, endorsed this criticism 
 of British rule, from his experience in the West 
 Indies and in the Islands of the Pacific. Spain and 
 Portugal, in his mature opinion, were far ahead 
 of us in colonial methods, at least in so far as the 
 happiness of the people was concerned. In South 
 America there were French, British and Dutch Guiana, 
 side by side, at peace but always in difficulties ; on 
 either side and to the south, Brazil and Venezuela, 
 the products of Portuguese and Spanish colonisation 
 
54 HEALTH AND EMPIRE 
 
 and till recently the subject of constant revolutions, 
 were progressing soundly and with inhabitants per- 
 fectly content. Revolution, we may say, is an un- 
 pleasant occupation. But then we do not hail from 
 Venezuela or Brazil ; and they who do, so the argu- 
 ment ran, enjoy the excitement of revolution as part 
 of " the gamble in life." 
 
 Another chance friend, a British sea-captain at 
 Singapore, after many years' experience in the 
 Dutch Archipelago and the Pacific, was convinced 
 that the Filipinos had formerly been far happier 
 under Spain than they were now under the United 
 States. They, too, had enjoyed their " gamble in 
 life " ; and it seemed evident that, in foisting 
 European commercial or military competition on a 
 country as foisted I believe it must be and in 
 training the inhabitants to this end by an education 
 and administration on European lines, we must go 
 slowly to work, we must temper the wind to the 
 shorn lamb. 
 
 My host in the Malay States made an interesting 
 forecast from fear of the giving out of the tin after 
 ten years. Malaya was enjoying the gamble in life. 
 Seven-tenths of the world's tin came from Malaya ; 
 72,000,000 out of 78,000,000 dollars-worth of their 
 exports were tin; their imports were 7! per cent, 
 higher in 1903 than in the previous year, their 
 exports 13 per cent., and it was on this trade that 
 the public revenue mainly depended. The tin, as at 
 present worked, is an alluvial deposit ; and, should 
 the alluvial deposit be worked out, it seemed doubt- 
 ful if the underground mines of gold and other 
 
THE GAMBLE IN LIFE 55 
 
 minerals, then being explored, would be able to 
 keep up the revenues. If not, Malaya would gradu- 
 ally revert to an agricultural country, and would 
 have to depend for revenue on the success of rubber 
 and coffee. These crops were in consequence being 
 planted right and left in places where jungle had 
 been cleared away by axe and by fire. With the 
 extraordinary recent advance in the demand for 
 rubber, this prospect draws near. Malaya will have 
 profited by her gamble. But it is in any case ques- 
 tionable whether it is not far better to develop the 
 natural resources of a country slowly than to trust 
 to an industrious and usually imported community, 
 produced by rapid development, to discover new 
 sources of revenue. In other words, it is suggested 
 that " the gamble in life " be allowed to die a natural 
 rather than a violent death. 
 
 We are inclined to laugh at the experience of Dutch 
 administration in the East Indies. The Achinese 
 were still, when I last heard of them, at war with the 
 Dutch. The war had lasted twenty-eight years, 
 scarcely a single expedition from headquarters had 
 ever returned successful, and not a few may be said 
 never to have returned at all. This need not be due 
 to sheer weakness of the parental government ; it 
 may equally be due to an instinctive if unconscious 
 principle that, although the East Indies be coloured 
 Dutch on the map, it is wisest to leave the Achinese 
 by degrees to conform to the new authority. 
 
 Is the British rule of " inferior " races the best ? 
 According to European ideals, it is by far the best 
 that the world has yet seen. A medical missionary 
 
56 HEALTH AND EMPIRE 
 
 passing through Mombasa on his way to Lake Nyasa, 
 was immensely struck by the difference it showed 
 between German and British methods. Along the 
 sea-front he described a magnificent row of com- 
 mercial and official buildings in permanent material, 
 with the German flag waving overhead and German 
 sentries smartly pacing the ground down below ; 
 but behind the sea-front there was not a sign of the 
 German invasion. The Germans, it would seem, 
 would wish to impose their military system, complete 
 and unchanged, on their East African possession ; 
 but they have little or no desire to permeate the 
 country or by degrees to imbue it with the ideas 
 which are the necessary preliminary to the accept- 
 ance by races of small intelligence or culture of 
 modern rule on Western lines. The same, I am 
 confidently informed, is the case in German South- 
 West Africa ; the same appears to have been the 
 cause of the trouble in the Shantung Province of 
 China, which led to the Boxer outbreak ; the same 
 was the cause of the Opium War, for which we must 
 be held to have been largely responsible ; and indeed 
 the same has been a common experience amongst 
 all colonising nations. If it be sought to make a 
 colony immediately self-supporting, above all with 
 an extravagant officialdom and expensive show of 
 administration, the natives have to be taxed for 
 what they do not want ; and, if there is any vigour 
 of organisation amongst them, the natural result is 
 revolt they prefer " the gamble in life." 
 
 Our own greater success for, after many centuries 
 of experience with many set-backs, we are entitled to 
 
THE GAMBLE IN LIFE 57 
 
 call it success is due perhaps to the fact that we 
 yield a good deal to native feeling, we leave the burden 
 of rule so far as is possible on native shoulders ; we 
 let the gamble go on under supervision. An in- 
 stance occurred in the Plague Regulations issued 
 by the Punjab Government in 1903. The only 
 compulsory duty on local authorities in respect to 
 plague was to notify to the deputy commissioner 
 and the civil surgeon of the district the first five 
 cases that occurred. The infringement even of this 
 sole duty was never to my knowledge in any way 
 punished ; and infringement, to my knowledge, 
 under inexcusable circumstances, was frequent, and 
 most serious in its results. All else was optional. 
 " Let the people die," said the government, in 
 effect. ' They look upon it only as a visitation of 
 God. We suffer no discredit, and a policy of mas- 
 terly inactivity is both easy and cheap." No doubt 
 a policy proposed from their laboratory stools by 
 many scientists in Berlin, Paris and London would 
 have led, as it did lead in Poona, to native risings and 
 serious discontent. But a more definite policy with 
 regard to the plague might with advantage have 
 been adopted ; it is one of many instances of British 
 yielding to native feeling in the hope that, as has 
 been said in another connection, we may muddle 
 through somehow. 
 
 It is easy to multiply examples of this principle. 
 In India we see it, for instance, in the freedom 
 allowed to the National Congress and to the remark- 
 ably feeble native Press ; in Natal our partial 
 adaptation of native Zulu law, our institution of 
 
58 HEALTH AND EMPIRE 
 
 special courts for dealing with native cases, our 
 maintenance of various tribal customs, are remark- 
 able. The position reached by the Maoris in New 
 Zealand and by the negroes in the West Indies is 
 evidence of the effect attained in many generations 
 by sympathetic attention to the real native needs. 
 Finally, our tolerance of native religion in all the 
 five continents is proverbial. We have done our 
 best, in some cases at least, to lend support to " the 
 gamble in life." 
 
 But at the same time we must not give in to a 
 false sympathy with such native customs and pre- 
 judices as, whether right or wrong from the native 
 standpoint, are a direct obstacle to the extension of 
 our effective rule ; nor must we on the other hand 
 so transfer our feelings to the persons of the subject 
 races, with whom we sympathise, by imagining that 
 they feel as we should feel under similar circum- 
 stances. An instance in point is the abolition of 
 slavery. No doubt there was much oppression and 
 cruelty, and as to the need of suppressing the slave 
 trade as it existed and unfortunately still exists 
 in Central Africa there can be no two opinions. 
 But looking back on the system of slavery, and com- 
 paring it with the condition of liberated slaves and 
 their descendants, there can equally be no doubt 
 that many slaves were happier in their slavery 
 than they now are in their freedom. It is absurd 
 to imagine that any intelligent slave-owner would 
 wilfully damage, still less kill, the slaves in his posses- 
 sion. A slave was a valuable asset ; as a master 
 cares for his horse or his motor car nowadays, so he 
 
THE GAMBLE IN LIFE 59 
 
 would naturally be careful of the well-being of his 
 slave. Ignorance and brutality might well be 
 guarded against by a proper system of inspection 
 and organised philanthropy, as is usual now in the 
 more civilised lands for animals and children. The 
 government might then have been saved the dis- 
 credit of having thrown a large body of innocent 
 helpless creatures upon the mercies of a hard world, 
 with which upon their own initiative they were quite 
 unprepared to cope. Moreover, a large proportion of 
 slaves, kept under good conditions, would prefer a 
 state of slavery, if only for the sake of the larger 
 stake it offers in " the gamble of life." 
 
 A false, although not to my mind excessive, sym- 
 pathy was thus recently displayed for the Chinese 
 coolie. Those who declaimed against the Chinese im- 
 portation to South Africa should have paid a visit to 
 Singapore, taken steamer to Port Swettenham, and 
 trained up through thirty miles of jungle to Kuala 
 Lumpur, the capital of the Federated Malay States. 
 The little single line, cut through the dense forest, 
 emerges suddenly upon a wide clearing and here is a 
 model town, rich in fine buildings, alive with official 
 and commercial activity, and humming with pro- 
 sperity. Of its 32,000 inhabitants, 23,000 were 
 Chinese, the descendants of Chinese imported labour. 
 Selemban, the capital of Negri Sembilan next door, 
 was a similar instance of the extraordinary prosperity 
 directly due to the imported labour, and just before 
 my visit 7000 labourers had been imported by a 
 Chinese contractor. No one could say that these 
 labourers were discontented or troublesome, or that 
 
60 HEALTH AND EMPIRE 
 
 they were badly paid, or that the country had not been 
 developed to a most astonishing extent and with 
 astonishing rapidity owing to their work ; while the 
 prosperity of the most successful Chinese merchants, 
 many of whom started life as coolies and now have 
 palatial mansions in Penang, was the most complete 
 answer to the denunciation of the institution of a 
 similar system in South Africa on any humane 
 grounds. To those whose ideal, regardless of the end, 
 is progress and development two very popular 
 catch-words Chinese labour has been the saving 
 feature in Malaya. But it is a question for statesmen 
 whether the Malay States or the Malays or the world 
 have gained by this progress and development. 
 
 The first batch of Chinese coolies for the Transvaal 
 sailed from Hong-Kong in high spirits a day or two 
 after my arrival ; and later on a visit to Tien-tsin 
 enabled me, in company with an Oxford Fellow, who 
 was organising the experiment in China on behalf 
 of the Transvaal Chamber of Mines, to call at Li 
 Hung Chang's workhouse, and see the material from 
 which the second batch were drawn. No system 
 ever conceived by General Booth for emigration and 
 employment of the workless could claim a greater 
 right to sympathy from the philanthropist. Again 
 be it repeated, Let us beware of false sympathy with 
 picturesque versions of native feeling. 
 
 Our rule succeeds in comparison with that of other 
 European states because we give considerable tether 
 to those whom we rule ; but at the same time our 
 rule also succeeds because we insist on certain de- 
 finite principles. The day before my arrival on a 
 
THE GAMBLE IN LIFE 61 
 
 visit to Peshawar, a Ghazi had tried to shoot a 
 colonel at point-blank range from behind, on the 
 railway platform. Fortunately the pistol missed 
 fire. Now, had a too sympathetic or inactive 
 administrator been in power at Peshawar, some days 
 would have elapsed before the culprit had been 
 brought to justice, and his fame meanwhile would 
 have gone round all the neighbouring hill tribes. 
 But the late Colonel Deane was no milk-and-water 
 administrator of the North- West Frontier Province. 
 A properly constituted court was assembled before 
 twenty-four hours had elapsed ; the prisoner was 
 fairly tried, condemned to death and hanged ; and 
 by the time the hill tribes had heard of his fanatical 
 deed they had also heard that the British power had 
 vindicated its authority. 
 
 A few clear principles appear to have been evolved. 
 Cruelty, in whatever form, must be suppressed ; and, 
 however closely it be allied with the ritual of religion, 
 a firm and determined attitude towards it by the 
 central government soon extinguishes it without 
 disturbance, where half-hearted measures might 
 provoke dissatisfaction, if not a mutiny. Jagernath 
 no longer crushes thousands to death beneath his 
 triumphal car, and widows are no longer allowed to 
 submit themselves to the rite of sati and perish on 
 the funeral pyres of their husbands. But at the 
 same time we temper our determined attitude in 
 such instances by a policy of absolute indifference 
 in cases where no such cruelty exists, as for instance 
 in such ceremonies as the tribal rites of circumcision 
 among the natives in British Kaffraria and the 
 
62 HEALTH AND EMPIRE 
 
 aborigines of Australasia. Vigorous administration 
 is no bar to peaceful government indeed, it is a 
 guarantee. Our Foreign Office rightly protects our 
 missionaries, who represent to the coloured races an 
 essential aspect of the European power, however 
 much the European public would often willingly 
 disown it. Stringent liquor laws also are an acknow- 
 ledged essential in the treatment of uneducated races ; 
 and again I would say that a bold policy in connection 
 with the plague in India would have been better than 
 all the half-measures with which it has been con- 
 fronted, far better than the executive indifference 
 with which it was met in the winter of 1903-1904. 
 Half -policies are of the devil ; a vigorous rule is what 
 native races require, and some remains of " the 
 gamble in life." 
 
CHAPTER III 
 
 THE MAD DOG 
 
 History of the Pasteur Institute of India. The Pasteur 
 Institute at Kasauli is an institution of remarkable 
 value, recently established under the patronage of 
 the Indian government, although an independent 
 concern. The tale of its foundation is amusing and 
 instructive. It was told me by the Director-General 
 of the Indian Medical Service, himself president of 
 the committee of management, in a walk one morning 
 before breakfast round Jakko, the monkey-haunted 
 hill at Simla. The number of bites from mad dogs 
 and jackals throughout India is considerable. Death 
 from hydrophobia (rabies, la rage) is a painful pro- 
 cess, besides causing in the case of a soldier a definite 
 economic loss to the Indian army. For both reasons 
 the Indian government felt bound to give the 
 sufferers relief according to M. Pasteur's treatment. 
 But in order that this treatment should be effective, 
 cases have to be treated as early as possible, and in 
 any case before active symptoms of hydrophobia 
 appear. Up to a few years ago the only place where 
 this treatment could be carried out was at the 
 Pasteur Institute in Paris, and so to Paris all who 
 had been bitten by mad dogs or jackals were sent. 
 Each man thus sent cost the Indian government 100. 
 63 
 
64 HEALTH AND EMPIRE 
 
 Now, it was difficult to say whether the bite was 
 from a dog infected with hydrophobia or from one 
 which was merely vicious or irritated. In some 
 cases, of course, the subsequent history of others 
 who had been bitten by the same dog, or the sub- 
 sequent illness and death of the dog itself, was a 
 guarantee that the danger was real. In some cases 
 bacterial examination, or inoculation of healthy 
 rabbits from solutions of the infected brain, produc- 
 ing death in the rabbit with definite hydrophobic 
 symptoms, proved sufficient. And so the govern- 
 ment required that the animal, alive or dead, or at 
 least its head, should be sent to a laboratory for 
 examination. But supposing the dog or the jackal 
 refused to be caught, supposing the bite was in- 
 flicted on a dark night, or in a crowd, or in out-of-the- 
 way jungle, no such evidence would be forthcoming ; 
 and it became necessary to take general evidence as 
 to the truth of the victim's story. 
 
 But the journey to Paris at the expense of a 
 humane government was no infliction on the private 
 soldier ; indeed, he enjoyed it. He enjoyed leaving 
 a tropical climate for one to which he was accus- 
 tomed, he enjoyed getting away from Indian sur- 
 roundings to a city of white people, he enjoyed the 
 freedom from work and, above all, he enjoyed, on 
 completion of the treatment, his return to the 
 regimental depot in England, his place in the bat- 
 talion having meanwhile been filled by a recruit 
 fresh out from home. It therefore became a definite 
 object to be suspected of having been bitten by a 
 mad dog or jackal, and to be sent to Paris with this 
 
THE MAD DOG 65 
 
 provisional diagnosis. Tommy Atkins would pre- 
 sent himself to the regimental medical officer, 
 showing a wound on his forearm or shin, with a 
 yarn about a mad dog which had bitten him and 
 several natives, but had escaped before they could 
 catch it. Natives and dog would naturally enough 
 escape identification, and in the resulting doubt 
 Atkins secured the benefit and was shipped off west- 
 ward. After a time the doctors had their suspicions 
 aroused, and took to examining the bite with a 
 hand-glass, by which they were able often to find 
 that the wound was no bite, but merely a scratch or 
 cut, perhaps intentionally inflicted. Atkins, how- 
 ever, was equal to the occasion, and a machine 
 was actually discovered in barracks, consisting of a 
 dog's jaw mounted on a strong spring, for inflicting 
 a wound which could not by any means be proved 
 to have been inflicted otherwise than by a dog's 
 teeth. 
 
 The bill for sending soldiers to the Pasteur 
 Institute meanwhile rose higher every year, and 
 so the government decided to support a Pasteur 
 Institute of their own. But inasmuch as inocula- 
 tion of rabbits with the poison is an essential part of 
 the process of preparation of the vaccine, and inas- 
 much as such inoculation of animals is a cause of 
 indignation to anti-vivisectors, it was decided that 
 this should be a private institution, to which the 
 government of course subscribed a round sum in 
 payment for the benefit they received from it, as 
 they had previously paid 100 for every case sent 
 off to Paris. The Director-General of the Indian 
 
66 HEALTH AND EMPIRE 
 
 Medical Service presided over the fortunes of this 
 institution, in a private, not in a public capacity, and 
 for the directorship India was fortunate enough to 
 secure the services of Colonel (now Sir David) Semple, 
 one of the best scientific workers in the Royal Army 
 Medical Corps, whose reputation for sound scientific 
 work has been increasing yearly since its reorganisa- 
 tion. As director of the institute, Colonel Semple 
 had first worked at the Pasteur Institute in Paris, 
 thus becoming fully conversant with the methods 
 employed both in the treatment of hydrophobia and 
 in general medical research and bacteriology. A 
 visit to Kasauli on the way down from Simla to 
 Lahore amply repaid the discomfort of a couple of 
 nights in the dark and dismal native-managed hotel. 
 
 Situation. The site in itself is admirable. In 
 choosing the site for such a laboratory in India it 
 is necessary in the first place to choose a hill station. 
 For on the one hand high temperatures cause all 
 sorts of bacteria to flourish when they are not re- 
 quired, and in other ways interfere with the bacterio- 
 logical work, even when an ample supply of ice is 
 forthcoming a considerable addition to the expense 
 of the institution. On the other hand the confined 
 and exhausting work of research, much of it consisting 
 of detailed observation through the microscope, is 
 severe enough of itself for any human being under 
 the most favourable circumstances I hate it myself, 
 even at home. And with a temperature of 120 degrees 
 in the shade it is cruelty to expect any consistent work 
 in a laboratory, or the development of any original 
 
THE MAD DOG 67 
 
 ideas in research. In the second place, it is necessary 
 that the site shall be as central for purposes of com- 
 munication as possible. 
 
 Kasauli is on the very southernmost margin of the 
 series of hills, leading up 40 miles on to Simla and 
 200 miles on again to the summit of the Himalayas. 
 It is of itself 6000 feet above the sea, while a pre- 
 cipitous descent of 9 miles brought us to Kalka, 
 35 miles from the large cantonment of Ambala, 
 right down in the plains. From the rocky crags and 
 the best situated bungalows at Kasauli, the view 
 south and west, at sunset especially, was magnificent. 
 A dense mist hovered over the plain so many thousand 
 feet below ; at intervals the winding, twisting Sutlej 
 reflected up mirror-like the ruddy rays of the setting 
 sun, while behind us rose ridge after ridge covered 
 in green, with a distant glimpse of Simla and the 
 snow-shrouded range that screened us off from China 
 and Thibet. Here were stationed during the hot 
 weather a couple of European regiments and all their 
 camp-followers. Here was the army school of signal- 
 ling. Here, year in and year out, were established 
 Colonel Semple and his little knot of workers, opening 
 the doors of their institute daily to Europeans and 
 natives supposed to be in danger of hydrophobia, 
 from all parts of India, Burmah and Ceylon. 
 
 Administration. The real scientific research 
 worker is a distinct breed of mankind, and Colonel 
 Semple is one of them, to whom the whole interest 
 of life, hourly and daily, both in the present and in 
 the future, consists of research, and the welfare of 
 
68 HEALTH AND EMPIRE 
 
 the institution and of the administration that 
 supports it. At the same time his training in a 
 royal corps of his Majesty's service has made him 
 a good organiser and an efficient and practical man, 
 ready at all times to devise new methods, to review 
 his tenets in every fresh light, and to make the best 
 of what knowledge and means are in his power. 
 The whole place, even then in its third year, was a 
 model of scientific virtue and should convince any 
 government and any philanthropist of the advantage 
 to be gained by encouraging research. The Institute 
 itself is a capacious one-floored bungalow, originally 
 a private residence, opened for this purpose on the 
 9th of August 1900. It receives from government 
 1000 rupees a month, or 800 a year, instead of their 
 having to pay 100 for any soldier or his wife or child 
 to be sent to Paris. Few malingerers care to come 
 to Kasauli, for the treatment is, in anticipation, a 
 considerable and useful, though actually harmless, 
 deterrent. Even apart from the malingerers, the 
 Indian government thus secured the treatment of 
 161 persons belonging to the British army in the 
 year 1902-1903, which would have cost them under 
 the old regime over 16,000. This year, for their 
 800 inclusive subscription, they secured the treat- 
 ment not only of these 161, but also of 100 other 
 Europeans, of 36 of the native army, and of 240 
 native civilians a saving, in other words, of much 
 suffering, of many deaths, and of 15,200. 
 
 The animals that inflicted the bites in the 584 
 cases scheduled for the year included sixty jackals, 
 three cats, one mule and one fox, besides a man who 
 
THE MAD DOG 69 
 
 by his saliva infected 10 persons at Quetta ; all 
 the other cases were caused by dog-bites. 
 
 Hydrophobia : Principle of Treatment. The prin- 
 ciple of the treatment reads like a detective story. 
 The poison spreads not by the blood, but slowly, day 
 by day, along the nerves up to the spinal cord, and so 
 to the brain. It there takes fourteen days to 
 establish itself before causing any symptoms. Thus 
 in the laboratory, if a rabbit be infected with a dose 
 of the poison directly on its brain, symptoms occur 
 in fourteen days, whereas after a bite on hand or foot 
 symptoms do not occur for sixty days or more ; it 
 takes seven weeks, in other words, for the poison to 
 travel from hand or foot up to the brain, and a fort- 
 night more before it will cause any symptoms. The 
 object of treatment is to raise the power of resistance 
 to a maximum before the poison reaches the brain 
 centres. It is a race between burglar and policeman 
 if inoculation is in time to protect the brain before 
 the poison gets there, all mischief is prevented ; 
 if the poison gets there first, death may be the 
 result. 
 
 The poison is almost certainly due to a microbe, 
 and when we find the microbe, and are able to culti- 
 vate him, it will presumably be best to inject the 
 culture pure and simple. At present we have not 
 found the microbe ; so we take an extract that must 
 contain him from the brain of an animal that has 
 died of hydrophobia and breed him in the brain and 
 spinal cord of a live rabbit in the laboratory. After 
 death we hang the rabbit's brain and spinal cord up 
 
70 HEALTH AND EMPIRE 
 
 to dry, for the poison to lose its power ; at different 
 stages of this weakening process we make mincemeat 
 of the brain and spinal cord and the poison they 
 contain, and then inject this varied mixture into the 
 anxious patient. 
 
 Preparation ofAnti-rabic Vaccine. The manufacture 
 of the material to be injected is also of great interest. 
 The method is that originally described by Pasteur, 
 with a few modifications. Pasteur found that, when 
 the spinal cords of animals thus killed were hung up 
 to dry, the poison contained in them first gained and 
 then gradually lost in power ; on the third day it 
 reached its maximum of virulence, on the seventeenth 
 day it was entirely innocent. By injecting first of 
 all a solution of infected spinal cord that has hung 
 for seventeen days, then cord that has hung for six- 
 teen, fifteen, fourteen days, and so on until the 
 patient is able to tolerate the injection of cord that 
 has hung only three days, no untoward effects what- 
 ever are noticed, and the patient is able to cope with 
 any poison that may then reach his brain centres. 
 But this spinal cord prepared in the laboratory this 
 medicine, as we may consider it varies in strength 
 according to the animal from which it has been pre- 
 pared, and Pasteur therefore made a further most 
 valuable discovery when he found that, by injecting 
 the poison from any hydrophobic animal into a 
 rabbit, and from that rabbit after death into another, 
 and so on in succession, the poison grows in virulence 
 until it at last reaches a definite standard, known as 
 " Pasteur's fixed virus " or rabies vaccine, which 
 
THE MAD DOG 71 
 
 produces its first sign of disease in a rabbit on the 
 seventh day, and death on the tenth or eleventh. 
 
 With this fixed virus you start your anti-rabic 
 institute and treatment. To prepare a stock of the 
 vaccine of different strengths, the spinal cords are 
 removed from rabbits that have died from inocula- 
 tion with this fixed virus. For this purpose the 
 rabbits after death are trephined, and the whole 
 spinal cord quickly and aseptically removed. The 
 cords are then divided up the middle, and each half 
 suspended on silk in sterile stoppered glass jars con- 
 taining enough solid caustic potash to dry them at 
 least twice over. At the same time a tube of sterile 
 meat broth is "inoculated" from the surface of the 
 cord ; any pollution of the cord would show a visible 
 growth of bacteria in this broth in a few days ; the 
 absence of any bacterial growth within three days 
 shows that the cord was not contaminated by other 
 infection. At the same time also an emulsion from the 
 brain of the dead rabbit is inoculated into a fresh rabbit 
 to keep up the series, this being done on successive 
 days. Colonel Semple was able to show me a row of 
 bottles containing third-day cord, fourth-day cord, 
 fifth- day cord, and so on up to fourteenth-day cord. 
 
 It is a question whether the virulence -or the quan- 
 tity of the poison is diminished while these cords are 
 hung up to dry. A professor at Buda-Pesth says it 
 is the amount of poison that is diminished, and that 
 he gets equally good results by injecting doses of 
 three-day cord in diminishing dilution and increasing 
 quantity. If this were established, anti-rabic work 
 would be immensely simplified and would become 
 
72 HEALTH AND EMPIRE 
 
 available in every bacteriological laboratory, instead 
 of in elaborate institutes only. 
 
 The inoculation of the rabbits is performed under 
 chloroform. A neat midget trephine removes a 
 small bony disc from the skull ; the needle of the 
 syringe is inserted direct into the brain ; the scalp 
 wound is left to heal up, as it does perfectly well 
 within a few days ; and the rabbit is immediately 
 returned asleep to its cage, the whole operation taking 
 perhaps three minutes. Dr. Kitasato, in Japan, on 
 the other hand, in his research laboratory in Tokyo, 
 does not even trephine, but injects the poison 
 directly, under chloroform, by a needle of the pre- 
 cisely requisite length, along the side of the eye and 
 optic nerve, through the optic foramen into the brain. 
 This method seems astonishingly simple and ingeni- 
 ous, but I must confess that the first rabbit I saw 
 thus treated died on the spot, all attempts at artificial 
 respiration proving useless. 
 
 The difficulty of conducting such treatment in this 
 institute may well be imagined, for the virulence of 
 the cords decreases daily, and on any one day ar- 
 rangements may have to be made as, for instance, 
 on the day of my visit for thirty-six doses of all 
 degrees of virulence so many of third-day cord, 
 so many of fourth, so many of seventh, and so 
 on. Two rabbits were inoculated for the purpose 
 of preparing virus every day, however few patients 
 there might be in the institute. The cord, which is 
 used within the first three days to supply fixed virus, 
 is depended on to supply virus on each successive 
 day, of diminishing virulence, until it has all been 
 
THE MAD DOG 73 
 
 used by the end of the fourteenth day. Should both 
 the rabbits inoculated on any day die, or their cords 
 after death become contaminated at any stage be- 
 tween the inoculation and the attainment of the 
 standard of virulence for which the cords are to be 
 used, the gap in the treatment of all patients is 
 definite and irreparable. 
 
 Extreme care has therefore to be taken in the 
 drying-room, in which the cords are kept at a uniform 
 temperature, at a uniform degree of moisture of the 
 atmosphere and devoid of all light, the walls and 
 ceiling being papered in black ; for moisture, light and 
 heat are all disturbing elements. 
 
 For each dose half-an-inch of the cord is cut off 
 with sterile scissors and mashed up with a teaspoonful 
 of salt (normal saline) solution, being used one day as 
 third-day cord, the next as fourth-day cord and so on. 
 
 Course of the Treatment. When a patient arrives 
 at the institute he is seen by the director, and is 
 ordered treatment according to the intensity and pre- 
 sumed danger of his case. In ordinary cases it will 
 be as follows : ist day, an injection of fourteenth- 
 day cord ; 2nd day, thirteenth-day cord in the morn- 
 ing and twelfth-day cord in the evening ; 3rd day, 
 eleventh and tenth day cords ; 4th day, ninth and 
 eighth ; and, on successive days, seventh, sixth, fifth, 
 fourth, and third day cord respectively ; then, on 
 the nth day, back to seventh and sixth day cords, 
 and, on successive days, fifth, fourth and third ; on 
 the I5th day again, sixth and fifth day cords ; then 
 fourth and third ; on the i8th day, sixth and fifth ; 
 
74 HEALTH AND EMPIRE 
 
 and, if necessary, fourth and third day cords on the 
 igth and 20th days, to end up with. By this time 
 the patient is thoroughly immune against infection. 
 But if the poison has reached the brain even only a 
 day before this the immunity may be too late. The 
 poison takes fourteen days to produce signs of the 
 disease ; so it is not till fourteen or fifteen days later 
 that the danger is over, five weeks in all from the 
 beginning of the full course of treatment. 
 
 In the worst cases an intensive form of treatment 
 is adopted, working up to third-day cord as quickly 
 as the patient can bear ; and in these it is an exciting 
 but anxious task to look out for any signs of hydro- 
 phobia, that may show that the treatment has been 
 too late, or any signs that may show that the treat- 
 ment has been pushed forward too rapidly. Should 
 signs of the disease occur during the course of the 
 treatment or within fourteen days of its completion, 
 plus one which must be allowed for the injection to 
 take effect, the poison must have reached the patient's 
 brain centres before they were up to full three-day 
 cord immunity that is, he came to the institute too 
 late, and his case therefore is not counted in the 
 statistics given on page 78 as a failure. Of these cases 
 there were six in the year under consideration, four 
 of whom developed symptoms during treatment and 
 two within a fortnight of its completion. Of absolute 
 failures, despite treatment, we have seen that there 
 were only six, a proportion of 1*02 per cent. The 
 larger and more ragged the bite, or the nearer it is 
 to the brain, the greater will be the chance of rapid 
 infection and the need of prompt treatment. 
 
The Verandah at Kasauli. 
 
 Patients from all India, waiting for the daily prick of the needle, to save them, 
 thanks to vivisection, from the most awful of deaths. 
 
THE MAD DOG 75 
 
 It was interesting to pass from the laboratories 
 into the consulting-room, to see all the doses standing 
 ready in little glass dishes on a side table, labelled for 
 the patients for whom they were severally destined ; 
 to watch the process of injection, the dipping of a 
 needle into carbolic oil and the plunging of it into 
 the skin of the flank, a practically painless operation, 
 over in less than a minute. But the greatest interest 
 of all was in wandering out on to the verandah, to 
 see the variety of patients assembled for their morn- 
 ing dose half-a-dozen British soldiers in khaki, sent 
 over from Burmah, where they had all been bitten 
 by the same dog ; a sergeant's wife from Rawal 
 Pindi ; a clerk from the offices at Madras ; a couple 
 of Sikhs in flowing garments, with their beards 
 twisted up into the long hair knotted under their 
 turbans ; a Parsi from Poona, and his fat little boy, 
 dressed in garish colours ; a fakir in a loincloth, his 
 body smeared over with dried clay and his hair 
 knotted and matted with dirt (Plate 8). 
 
 Is not this the very essence of a modern paternal 
 government ? Is it not one of the strongest factors 
 in securing our rightful position of responsibility over 
 the uneducated, childlike, helpless races of India ? 
 
 Antitoxin. Colonel Semple was trying to produce 
 a satisfactory anti-rabic serum to develop, in other 
 words, and to employ for treatment, the natural 
 antidote, whatever it may be, by which under certain 
 circumstances a living animal may resist the poison 
 of rabies. This would obviously be a far more cer- 
 tain method than that of vaccination just described. 
 
76 HEALTH AND EMPIRE 
 
 The present method seeks only to train the brain 
 tissues, by gradual inoculation of the poison in in- 
 creasing doses, to produce the natural antitoxin and 
 so resist the poison from the bite, if the poison from 
 the bite shall not have gone there first. The proposed 
 method would mean the inoculation of the actual 
 antidote, which could act on the brain centres even 
 after they had become affected. By the new method 
 ponies were being trained to manufacture antitoxin 
 by being inoculated, as the patients at the institute 
 were being inoculated, with increasing doses of the 
 poison. The healthy little pony I saw being inoculated 
 with blinkers on, to which process he showed no objec- 
 tion (Plate 9, p. 82), was now after seven months 
 able to stand so large a dose of fixed virus as would 
 have killed him, seven months before, six thousand 
 times over. After eight months the ponies were able 
 to stand the amount of virus contained in the whole 
 fresh brains of two rabbits, dead from the acutest 
 form of the poison. A fortnight later some of the 
 pony's blood would be drawn off, and tested in 
 a test-tube against the strongest form of rabies 
 poison, inoculation with this mixture of poison and 
 antidote being found, when properly mixed, to pro- 
 duce no symptoms on inoculation into rabbits. Con- 
 sidering the proved value of the treatment already 
 in force, in Paris, in Kasauli and elsewhere, Colonel 
 Semple did not dare to experiment with his new 
 method on human beings in the place of the old 
 method, but he used it as a preliminary to the usual 
 methods in badly bitten and late cases, thus giving 
 the patient, it is supposed, an antidote to ward off 
 
THE MAD DOG 77 
 
 the attacks of the poison, until by the usual methods 
 the patient's brain centres should be sufficiently 
 immunised to resist the poison of their own accord. 
 Before long it is hoped that this serum may have 
 proved its value ; then it will be distributed like 
 diphtheria antitoxin or any other medicine to all 
 parts of the earth where there is danger of hydro- 
 phobia. With ordinary care it may be kept and 
 inoculated by any medical practitioner, and many 
 cases which are unable to reach a duly established 
 Pasteur Institute will thus be saved from death. 
 Surely the value of a research institute was never 
 so clearly proved. 
 
 Results. As regards results, the patients at 
 Kasauli are classified as follows : Class A., those 
 bitten by animals proved either experimentally or 
 by the development of the disease in other persons 
 or other animals bitten by them to have had rabies ; 
 Class B., those bitten by animals certified by a 
 veterinary surgeon to have had rabies, after examina- 
 tion before or after death or both ; and Class C., 
 those bitten by animals suspected of rabies in 
 other words, the certain, the probable, and the 
 possible cases. Each of these classes is again divided 
 into three sub-classes, according as they are bitten, 
 (i) on the head or face ; (2) through the exposed 
 skin on any other part of the body ; (3) through 
 the clothing in other words, the most dangerous, 
 the medium, and the least dangerous form of bite. 
 In the year before my visit, 62 certain cases 
 amongst Europeans had been treated, 43 probable, 
 
78 HEALTH AND EMPIRE 
 
 and 164 possible, giving a total of 269 European 
 cases, without one failure ; while at the same time 
 42 certain cases amongst natives, 27 probable, and 
 246 possible, or 315 native cases in all, had been 
 treated, and of these there were only 6 failures ; 
 giving a percentage of rg. These 6 failures were 
 merely suspected cases ; 2 had been bitten on the 
 head or face, and 4 on exposed skin elsewhere. 
 Bites through the clothing, it will be noted, are not 
 very dangerous, for the teeth which do the deed are 
 wiped clean of the poison in their passage through 
 the clothes. 
 
 So again in the previous year, there were no failures 
 out of 215 Europeans treated, while the 7 failures 
 out of 328 natives treated were in cases in which 
 the bite was of the more dangerous kind. There are 
 many obvious reasons to account for this racial 
 difference. The Europeans were less severely bitten ; 
 their wounds were more promptly and better treated 
 immediately after the bite ; they reached Kasauli 
 usually at an earlier stage for treatment ; being 
 healthier and stronger in themselves, and better fed 
 before, during, and after immunisation, they were 
 enabled to offer more resistance to the infection that 
 may have been in them. The small proportion of 
 patients classed as bitten by animals proved rabid 
 is illustrative of the difficulties of tropical work. 
 For if the brain or spinal cord, on which the diagnosis 
 was to depend, were sent improperly preserved, it 
 would arrive putrid, and injection of its juices into 
 a rabbit would cause death from blood-poisoning 
 before there was time to wait the fortnight for 
 
THE MAD DOG 79 
 
 hydrophobia to develop. If, on the other hand, the 
 specimen were sent in spirit, the spirit would destroy 
 the virus of rabies and injection would in any case 
 cause no disease. To preserve the specimen in ice 
 is not always convenient in a warm climate, and the 
 only certain method is to preserve it for its journey 
 to the hills in sterile neutral glycerine. 
 
 \j */ 
 
 Under these circumstances, doubt may occur 
 whether the results recorded do not give a fictitious 
 idea of the value of the treatment ; for a consider- 
 able number of the patients treated would not 
 presumably have developed rabies in any case. But 
 the doubters may be pretty certain that the journey 
 to Kasauli and all the discomfort and expense it 
 entailed were not undertaken without really good 
 reason for believing that the bites had been inflicted 
 by rabid animals ; and it will be seen that one-third 
 of all cases were actually proved genuine by the 
 animal before death, or the extract of its brain after 
 death, causing death in other animals either in the 
 laboratory or in the streets of the place whence the 
 patient had come. Then it may be suggested that 
 the number of failures is quite understated ; the 
 report, for instance, for 1903 corrects the report for 
 1902 by giving 2 deaths, respectively three months 
 and six months after the completion of treatment. 
 But it is improbable that there are many such 
 omissions ; for every patient on leaving Kasauli is 
 given a stamped and addressed postcard, which he 
 is to send up to the institute three months later, 
 giving a general account of his health, and, on the 
 receipt of these cards, fresh cards are sent, and so on 
 
80 HEALTH AND EMPIRE 
 
 until all danger is over. One might expect that in 
 the result few of these cards would be returned, but 
 in point of fact they are all returned. I suppose the 
 village munshi or the schoolmaster does the writing 
 for the illiterate native. 
 
 I have often wanted to have this system of in- 
 formation as to after-results adopted in the big 
 London hospitals, but the difficulties when the idea 
 has been mooted have been considered too great. 
 Here, however, is an instance of its success under far 
 more difficult circumstances. 
 
 A further fallacy is avoided in that twenty persons 
 in one year and ten persons in the next were not 
 treated, and are not reckoned in the above numbers, 
 as their information seemed to show that the treat- 
 ment was unnecessary. 
 
 Smallpox Vaccine. But the value of the Kasauli 
 Institute does not end here. One department is 
 engaged in the preparation of smallpox vaccine for 
 the whole of the Punjab, and vaccine is a medicine 
 given to the people by the government which they 
 fully appreciate as an almost complete preventive 
 against a disease which in India is so great a scourge. 
 This vaccine is now sent out, according to improved 
 modern theory, preserved in glycerine, which kills off 
 any contaminating germs within a fortnight ; or, if 
 urgently required, it is sent out in chloroform, which 
 kills off contaminating germs at once ; so that, on 
 receipt of an order for lymph on Monday morning, 
 a calf can be at once inoculated, and sixth-day lymph 
 sent out ready for use on Saturday. One interesting 
 
THE MAD DOG 81 
 
 difficulty is that of caste, the Hindus down in Mysore, 
 although not those in the Punjab, objecting to the 
 use of the sacred calf for the preparation of vaccine. 
 But the buffalo is not sacred, and vaccine is there- 
 fore prepared for these conscientious objectors from 
 the buffalo calf, the only difficulty being that the 
 lymph in the buffalo deteriorates in its passage in 
 inoculation from one to another, and its virulence 
 must be raised after every third passage by passing 
 it through a child or a calf. 
 
 The buffalo, as I have said, is not a sacred animal ; 
 it is one of the ugliest of beasts ; and the story of its 
 creation in Hindu folk-lore fully explains its appear- 
 ance and its non-sanctity. For Adam, the first of 
 men, looked out upon God's creation, and saw how 
 beautiful were the animals that the Almighty had 
 created. " Let me also create an animal," he im- 
 plored the Almighty. The Almighty granted his 
 request, and the result is the buffalo. 
 
 Snake-venom. Hydrophobia and smallpox are the 
 two diseases that occupy most of the attention at 
 Kasauli, but a most important branch of research 
 work was being carried out by Captain Lamb, of the 
 Indian Medical Service, on the subject of snake- 
 poisons. 1 These poisons are of two distinct and 
 separate kinds, the one derived from the cobra, the 
 other from Russell's viper. By laborious research 
 
 1 Unfortunately, as these pages go to press, news comes of the 
 untimely death of Major (then Captain) Lamb, by which India and 
 indeed the whole world are deprived of one of the most capable and 
 effective research workers in preventive medicine. 
 
82 HEALTH AND EMPIRE 
 
 an anti-venomous serum has been produced for each 
 of these poisons, an antidote produced by the gradual 
 inoculation of ponies with the respective venom. 
 The advance in knowledge in this subject has occurred 
 simultaneously under Captain Lamb at Kasauli and 
 under M. Calmette at Lille. The anti-venenin, as it 
 is called, which was prepared at Kasauli neutralised, 
 dose for dose, half as much again of cobra-venom as 
 that prepared at Lille. 
 
 The method of collecting snake-poison, for the 
 purpose of immunising the ponies and preparing the 
 antidote, is as interesting to the spectator as it 
 appears to be dangerous. The process was shown 
 me at Professor Haffkine's laboratory, belonging to 
 the Bombay government, a few miles out of that 
 city, at Parel. The snakes are kept in Huntley & 
 Palmer's biscuit-tins, covered in by fine rabbit- 
 netting in the place of a lid, and are under the 
 charge of the cleverest snake-charmer in India, 
 retained for the purpose at what to the native is the 
 princely salary of 25 rupees a month, or 20 a year 
 all told (Plate 9) . The cobras are milked, as it is called, 
 once every seven or ten days. They are turned out 
 at the end of this fast one at a time from their tins, 
 the neck pinned down by the charmer with the 
 end of his stick and the tail by his bare foot. He 
 then seizes them behind their jaws between his finger 
 and thumb, while an assistant holds a sherry-glass, 
 covered with American cloth, through which the 
 cobra plunges his fangs the fangs on the upper jaw, 
 about in the site of our canine teeth, the cobra's one- 
 sixth of an inch and the viper's half-an-inch long. As 
 
(a) The Colonel Injects enough Poison to Kill 6,000 Ponies </>. 76) 
 (b) Milking a Cobra at Parel (/>. 82). 
 
THE MAD DOG 83 
 
 the fangs moult, one is able to procure specimens. 
 The snake having bitten into the American cloth, a 
 bright yellow, clear liquid, about half a teaspoonful, 
 escapes into the glass, and in a few hours crystallises 
 out. The cobra is fed through a glass thistle-shaped 
 funnel, thrust down his throat, with a quarter of a 
 pint of egg-and-milk mixture, and is finally returned 
 to his tin for another week or ten days, until he is 
 hungry enough to bite again. In this way the snakes 
 live for about eighteen months. The poison of 
 Russell's viper is extraordinarily virulent ; one grain 
 of it in the jugular vein will kill a horse in fifteen 
 minutes. It acts on the blood, causing rapid coagula- 
 tion, whereas the cobra poison acts on the central 
 nervous system. The new snake-house at Kasauli 
 is a model lodging-house for snakes, with a series of 
 cells covered and fronted in glass, properly ventilated 
 and easily cleaned, raised on a shelf at a convenient 
 height above the ground, in a hothouse kept under 
 proper conditions of temperature and moisture. 
 
 Anthrax or Splenic Fever. It would be impossible 
 to give in detail an account of the work in other 
 departments at Kasauli. Mention has been made 
 of work in connection with hydrophobia, smallpox, 
 and snake-bite, but much was being done in the 
 preparation of a vaccine against anthrax. Anthrax 
 or splenic fever is a great scourge in many civilised 
 countries ; it is still more of a scourge in India. 
 Statistics in France show that the mortality amongst 
 sheep in districts where anthrax is prevalent was 
 reduced by inoculation from 10 to I per cent., and 
 
84 HEALTH AND EMPIRE 
 
 amongst cattle from 5 to J per cent. The prepara- 
 tion of vaccine at Kasauli was in 1903 in its infancy, 
 but before long it was expected that it would do 
 much useful work. The value of anthrax vaccine 
 was of course recognised and put into action in 
 Japan during the recent war. At a visit to Dr. 
 Kitasato's laboratory in Tokyo I found that the 
 twenty-five-thousandth dose of anthrax vaccine had 
 just been completed. Every horse going out to the 
 war was injected twice, at intervals of ten to twelve 
 days. An attack of splenic fever amongst the limited 
 number of horses in the Japanese cavalry would have 
 been a fatal calamity. The government, however, 
 were forewarned, and, unlike some European govern- 
 ments, being forewarned took good care to be 
 forearmed. 
 
 Lockjaw. The same activity was being shown at 
 Kasauli in the preparation of an antitoxin against 
 tetanus or lockjaw, and the horses used in its pre- 
 paration were already in a fairly advanced stage of 
 immunity. This discovery again had been put into 
 practical use in Tokyo by Kitasato, who, with Von 
 Behring, discovered the antitoxin in Berlin in 1895. 
 In the wear and tear of the campaign in Manchuria 
 horses would be wounded, and there would surely 
 be danger of the wounds being infected by tetanus. 
 An ample supply was therefore prepared in good 
 time, and sent out to the seat of war. One may 
 wonder if on the Russian side any such foresight was 
 shown. In South Africa, certainly, no steps what- 
 ever were conceived against such a mere possibility. 
 
THE MAD DOG 85 
 
 Other Laboratory Work. At Kasauli also a diph- 
 theria antitoxin was being prepared. Two strains of 
 diphtheria obtained from Calcutta had been found 
 defective, but a virulent culture had been obtained 
 from England (pace the customs officers), and horses 
 were being immunised from this source. 
 
 Typhoid vaccine had also been prepared, and two 
 thousand doses sent out in five months. An anti- 
 toxin against blood-poisoning had been produced. 
 Researches had been undertaken in connection with 
 cerebro-spinal fever, plague and malaria, and samples 
 of blood and other material from different parts of 
 India examined for malaria, tubercle, bilharzia and 
 the diseases already mentioned. Samples of water 
 had also been examined in connection with water- 
 supplies. 
 
 Pamphleteering. Not less striking were the pam- 
 phlets prepared by the director for issue in connec- 
 tion with his various vaccines and antitoxic fluids. 
 Scientific men working in laboratories do not as a 
 rule sufficiently realise the importance of explaining 
 their methods to those who must use them and to 
 those on whom they are to be used. Pamphlets 
 issued from the Pasteur Institute of India gave full 
 descriptions, for instance, of vaccination against 
 typhoid fever, of the principles upon which it is 
 based, the composition of the vaccine, the methods 
 to be employed in the injection, the clinical symp- 
 toms that may be expected to ensue, the advisability 
 of a second inoculation, the signs and limits of its 
 success, and suggestions as to preservation of the 
 
vaccine and the keeping of records for statistical pur- 
 poses. The pamphlet was essentially prepared for the 
 use of medical men, and through them could be readily 
 interpreted as required to their patients. A similar 
 four-page pamphlet described the process of vaccina- 
 tion against anthrax ; another the use of serum 
 against snake-bites ; a fourth gave directions for 
 collecting and sending specimens of material for 
 diagnosis ; a fifth gave information as to the treat- 
 ment against hydrophobia for those who might come 
 to seek it. 
 
 In this matter of pamphleteering it must be 
 remembered that most medical men in practice are 
 not in touch, and a large proportion from their 
 training up have never had anything to do, with 
 recent methods of bacteriological work and treat- 
 ment ; therefore it is essential, in sending out the 
 vaccines, to explain to them their use. Pamphlets 
 enhance the value of such remedies a hundredfold : 
 without pamphlets the vaccines are of no more use 
 than the clinical thermometer, prescribed by the 
 Central Midwives' Board in England, to the village 
 midwife who is unable to read or write. Scientific 
 workers are apt to complain that the public do not 
 appreciate the value of their work, but the fault in 
 my opinion is their own; none but they are com- 
 petent to translate their results into terms within 
 the understanding of the common people, or even of 
 those of good general education. They should look 
 upon it as one of their most important duties to 
 spread the results of their work, briefly and in an 
 attractive form, through periodical literature, through 
 
THE MAD DOG 87 
 
 pamphlets, public notices and handbills, by public 
 lectures with lantern slides, and in any other way 
 that may suggest itself. This duty is fully recognised 
 and carried out by the director of the Pasteur 
 Institute at Kasauli. 
 
 The work at Kasauli has now been divided, that 
 dealing with hydrophobia being awarded the whole 
 of the Pasteur Institute, above described, with the 
 late Major Lamb as its head, while Sir David Semple 
 has been put in charge of all other work in a separate 
 and magnificent building, constituting the Central 
 Research Laboratory of India. 
 
 It is almost incredible that such work as I have 
 attempted to describe should have been done in 
 three years from the foundation of the Institute by 
 Colonel Semple, with only two European assistants 
 and one native, and with occasional help from other 
 medical officers, sent to Kasauli for brief periods of 
 study or spending their ordinary leave in the work. 
 Good wine needs no bush. 
 
CHAPTER IV 
 
 THE FLEA 
 
 THE first general research laboratory of the Indian 
 government is established in the interesting old 
 Government House at Parel, four miles north of 
 Bombay, on the Bombay-Baroda line. This house 
 was originally a Portuguese place of worship and 
 monastery, confiscated by the English government 
 on account of traitorous conduct by the Jesuits in 
 1720. Governor Hornby first took up his residence 
 there in 1771. A post on the staircase and a portrait 
 in the ballroom show the Duke of Wellington's con- 
 nection with the place, and King Edward stayed 
 there in 1875. Since 1880 the governors of Bombay 
 have lived nearer to their work and to the sea- 
 breezes at Malabar Point, and the old Government 
 House was, at the time of my visit in 1903, given 
 over to Mr. Haffkine. Haffkine's position was essen- 
 tially peculiar ; like Topsy, it " growed." The pre- 
 paration of plague serum and devotion to bacterio- 
 logical research on behalf of the Indian government 
 should obviously be the work, the privilege, and the 
 prize of the Indian Medical Service ; but he was not 
 even responsible to the director-general of that 
 service; he was an independent appanage of the 
 government of India. 
 
 88 
 
THE FLEA 89 
 
 Haffkine, a distinguished research worker under 
 Pasteur at the Pasteur Institute in Paris, working at 
 a prophylactic against cholera, succeeded in prepar- 
 ing a vaccine which would protect animals against 
 lethal doses of the cholera bacillus. With intro- 
 ductions from Lord Dufferin, then ambassador at 
 Paris, and others to the British government recom- 
 mending that the prophylactic should be tried in 
 India, facilities were accorded to Haffkine to pro- 
 secute his studies on the subject in India. He 
 proceeded to India at his own expense early in 1892, 
 and by 1896 succeeded in convincing the Indian 
 government that the prophylactic was valuable. 
 
 Up to 1895, 70,000 injections of living cholera 
 bacilli had been made in 43,000 individuals, and in 
 no instance did any bad result ensue, while it would 
 seem that the individuals thus injected were thereby 
 strengthened to resist infection. But the effects 
 were not entirely satisfactory, and it seemed likely 
 that an injection of more virulent cholera bacilli 
 (comma bacilli, as they are called, owing to their shape) 
 would give a more perfect result. Inoculation of 
 this virulent poison in guinea-pigs, however, produced 
 sloughing of the tissues at the site of inoculation. 
 Scientific heroism does not wince at self-vivisection, 
 and Haffkine made the bold experiment of inocu- 
 lating himself with virulent comma bacilli. Their 
 effect, he fortunately found, was harmless to man, 
 when carefully inoculated, and as a result the world 
 is in possession of a most valuable preventive against 
 a disease which kills millions in its oft-recurring 
 epidemics. One instance may be given. Twelve 
 
90 HEALTH AND EMPIRE 
 
 thousand coolies in the tea-gardens of Assam were 
 threatened with cholera ; roughly speaking, half of 
 these were inoculated and half not. Amongst those 
 not inoculated 200 cases of cholera occurred, with 
 124 deaths ; amongst those inoculated there were 
 only 27 cases and 14 deaths. Taking it for 
 granted that the inoculated and the uninoculated 
 were, in general, equally liable to infection, this 
 instance shows a saving of 147 cases and 95 deaths. 
 
 These and other researches, apart from those carried 
 out by Dr. W. J. Simpson, Health Officer for Calcutta, 
 were at Haffkine's own expense. In 1896 the govern- 
 ment of India asked Haffkine to proceed to Bombay 
 and study the plague. It was there he set about pre- 
 paring a prophylactic for the plague. 
 
 In 1897 Haffkine had already discovered and pub- 
 lished a method of fighting the new scourge new 
 at least in its extent and importance again testing 
 it first upon himself. His method consisted essen- 
 tialty in growing plague bacilli in solution of the 
 Japanese seaweed, agar-agar, in common laboratory 
 use, in which they not only lived and multiplied 
 visibly to an astonishing extent, but also produced 
 those poisons or toxins which are the actual agents of 
 the disease. This culture bacillus and all was then 
 heated, and the bacillus thereby killed. Injection 
 of the fluid was thus able to produce symptoms 
 owing to its contained poisons ; but it would not 
 produce the real disease, because the bacilli were 
 dead the manufacturers of poison were killed. 
 Inoculations then of Haffkine's prophylactic, in 
 large doses, might produce some of the symptoms of 
 
THE FLEA 91 
 
 the disease ; in small doses it only stimulated the 
 tissues of the body to produce an antidote and be 
 prepared to fight the real, living bacillus, if it hap- 
 pened to come along that way. 
 
 The Indian government recognised in Haffkine 
 a great possession, and it was greatly to their credit 
 that, laying aside all routine regulations, they retained 
 him in their service. A Polish Jew by origin, a 
 mystic and a man of reserve, who talks with care 
 and always to the point, his appearance is large 
 and striking, his general personality fascinating, 
 Napoleonic both in his presence and in his genius. 
 The magnitude of his work, the preparation of several 
 million doses of this prophylactic, required a genius 
 for management, and its supervision, one might 
 think, would have given him ample employment ; 
 yet at the same time he was able to carry on research 
 work in several other departments, just as Colonel 
 Semple at Kasauli was carrying on a vast amount of 
 work in addition to his special work concerned with 
 hydrophobia. 
 
 The series of rooms in which Haffkine's pro- 
 phylactic was being prepared constituted a factory 
 of considerable size. Shelf upon shelf was filled with 
 delicate glass bottles, half full of broth, dimly 
 illuminated by a stray gas jet. I saw the broth being 
 inoculated with plague culture, and the culture at vari- 
 ous stages growing down like stalactites from a scum 
 on the surface into the depths of the broth. I saw the 
 bottles heated and sterilised, thus killing the bacteria ; 
 their contents being sucked off in glass pipettes, that 
 make you long to blow soap-bubbles, and so dis- 
 
92 HEALTH AND EMPIRE 
 
 charged into little queer-shaped bottles, which, in 
 turn, were rubber-corked, labelled and packed. To 
 those who are used to the careful methods, in general 
 use, for sealing such products of the laboratory by 
 paraffin or sealing-wax, the method employed at Parel 
 seemed open to criticism, more especially when 
 carried out, as it was, by soldiers and natives of 
 indifferent education. It is true that many pre- 
 cautions, such as frequent passing of the necks of the 
 bottles and other apparatus through the flame, and 
 proper sterilisation of the bottles, were laid down in 
 the rules of procedure ; but there was a certain primd- 
 facie case to give grounds to those who, with consider- 
 able acquaintance of the Parel laboratory and its 
 methods, maintained that the death of eighteen 
 natives at Mulkowal from tetanus, after inoculation 
 against the plague, was due to some flaw in the 
 bottling at Parel. An account has already been given 
 of this most unfortunate incident, which set back 
 inoculation through the whole of India. The evil of 
 it lay, not in the bereavement of eighteen families, who 
 were consoled by seven hundred rupees each from the 
 government, nor in the more general effect on the 
 credit of the operation and on the credit of the 
 government, but in the loss by government itself 
 of confidence in the security of Haffkine's wonderful 
 invention, thereby undermining the position which 
 was gradually being acquired in official circles by 
 medical research. It is melancholy that the public 
 should appreciate so little the saving of thousands of 
 lives by Haffkine's prophylactic as to have allowed 
 so comparatively minute an accident to interfere in 
 
THE FLEA 93 
 
 any way with the life-saving work of Mr. Haffkine's 
 campaign. Would a general in the field be so 
 affected by the loss of eighteen men ? 
 
 Many fascinating observations were shown me 
 at Parel by Captain Liston of the Indian Medical 
 Service ; and one, which will be recorded in history, 
 was the evidence he had accumulated in support of 
 his view, little favoured at that time, that plague 
 was conveyed to man by the rat-flea. This sugges- 
 tion was first brought forward by M. Simond of the 
 Pasteur Institute in Paris in 1898. The rat-flea, as 
 he showed, is quite different from the flea that infests 
 man, and it only attacks man when it cannot find a 
 rat on which to live and is therefore hungry. 
 
 It is a common although not universal experience 
 that plague in any locality is heralded by the death 
 and emigration of the rats. When the surviving rats 
 have left the place, plague attacks the inhabitants. 
 It is easily demonstrated that, whereas the living rat 
 harbours a multitude of fleas, the dead rat, so soon 
 as the body has turned cold, is found absolutely 
 devoid of its parasites. We talk of the rats deserting 
 a sinking ship ; we may with equal truth talk of fleas 
 deserting a dying rat. The process is instinctive. 
 The flea draws its food from the rat's blood ; so 
 soon as the rat dies, the blood ceases to circulate and 
 soon clots. Forewarned is forearmed, and at death 
 the fleas troop off to seek pastures new. 
 
 If, while their late host has been sick and dying, the 
 other rats have fled, the fleas are left without further 
 resource ; they must perforce accept what food they 
 can, and they therefore fasten at once on Man. The 
 
94 HEALTH AND EMPIRE 
 
 hero of science had here again submitted his body to 
 the proof and triumphantly shown without doubt that 
 he could attract the attentions of the derelict rat- 
 flea. Now the rats thus found dead are found also 
 to contain in their blood a large number of unmistak- 
 able plague bacilli ; and as Major Ross proved the 
 presence of the malarial parasite in the stomach and 
 salivary glands of the mosquito fed on a malarial 
 patient, so Listen wished to show the presence of 
 plague bacilli digested and absorbed into the stomach 
 walls and salivary glands of the flea. He found them 
 in the stomach walls ; but this only shows that when 
 a flea lives upon blood its stomach will contain and 
 absorb any bacteria that blood may contain. Ross' 
 experiments with the mosquito only began here ; his 
 triumph ended when he was able to show the malarial 
 parasite passing into the salivary glands and down 
 the proboscis of the mosquito, waiting ready without 
 a doubt to infect the subject of the next bite. So 
 Captain Liston, to prove his point, had yet to prove 
 the path of the bacillus from the stomach of the flea 
 to the bite in the skin of the flea's victim. In fact 
 it now seems probable that the bacillus does not 
 infect the flea's saliva, but passes down the flea's gut, 
 and is evacuated with other food-debris when the 
 flea is feeding, being then rubbed in by various means 
 to the opening made by the bite. To Captain Liston 
 is due the credit of proving the cardinal fact. 
 
 This theory of rat-flea transmission as the usual 
 means of infection in bubonic plague explains and 
 draws support from several commonly observed facts. 
 Thus, in the Punjab, at least, the plague is commoner 
 
THE FLEA 95 
 
 amongst Indian women, who stay in the undoubtedly 
 flea-frequented houses and compounds of the village, 
 than in the men, who are out at their work all day. 
 It is by common opinion a soil disease, absent where 
 the floor of the dwelling and its surroundings are 
 clean, present most of all in the filthy hovels of mud 
 houses and the dark chawls, littered with rags and 
 refuse, in the slums of Bombay (Plate 10). 
 
 The most striking piece of evidence that met me 
 in this direction was the story of a gang of natives 
 employed in disinfection in the Punjab. Plague was 
 rife amongst them ; it was taken as a matter of 
 course, considering the nature of their work, and they 
 were paid on a correspondingly high scale ; but a 
 medical officer, recognising the danger of infection 
 through the feet and legs, obtained for them a Govern- 
 ment issue of leather boots and leggings. During 
 the ensuing season only one case of plague occurred 
 amongst them, and on inquiry it was found that the 
 patient had expressed a great dislike to the use of 
 boots and leggings, and had taken them off whenever 
 he thought he could escape observation. 
 
 But doctors differ until a truth is fully proved. In 
 the face of all this evidence, and the general opinion 
 of nine-tenths of those who had seen anything of 
 plague work, may be set the opinion of the late Dr. 
 Hunter, government bacteriologist at Hong-Kong, 
 which has also suffered heavily from plague since 
 1894. This young authority, already eminent at the 
 time of his recently lamented death, pointed out the 
 fact that the bubo frequently made its appearance 
 several days after the onset of the illness, and that it 
 
96 HEALTH AND EMPIRE 
 
 was not only one particular gland, but the whole 
 glandular system, that was more or less affected. He 
 concluded that plague was primarily a general 
 disease of the body at large, infected through the 
 food or air tracts, and that the affection of glands, 
 internal or external, with the eruption of buboes, was 
 merely a local manifestation of the disease, similar 
 to the skin eruption in smallpox and measles. This 
 was a return to the view of older writers, and would 
 have left us no nearer to the means of infection or to a 
 policy of prevention. But it was contrary to common 
 experience and is now finally abandoned. 
 
 The more usual form of infection in India is shown 
 by the buboes, the enlargement of glands in the groin, 
 the armpit, or the neck, whose normal function is to 
 filter the juice from every tissue in the body, on 
 its way to dilute the blood close to the heart. 
 The enlargement shows the endeavour of these 
 glands to arrest the flow of plague infection from a 
 fleabite on the ankle, or a crack under the finger-nail, 
 or a scratch on the face, into the general circulation. 
 The bubo may suppurate, may form an abscess, and 
 this is not necessarily opened by the knife. The 
 natives apply leeches or green herbs, and wait for 
 it to burst. But, whether it suppurate or not, there 
 is no danger to the life of the individual until this 
 natural filter has leaked and let through the plague 
 poison to the general circulation. Then it produces 
 fever, prostration, heart failure, and commonly death. 
 
 The common form, then, of Indian plague is spread 
 by the bite of the rat-flea. But elsewhere, and even 
 to some extent in India, outbreaks and cases not 
 
THE FLEA 97 
 
 uncommonly occur of the pneumonic form of plague, 
 in which the infection is perhaps derived from dust, 
 and leads to pneumonia, usually with fatal result. 
 Such was the case in the outbreak which originated 
 a few years ago in a laboratory in Vienna ; such too 
 the few cases that justly caused alarm last winter 
 in Essex ; such the outbreak in Manchuria resulting 
 in 60,000 deaths. Even in April, 1911, the inter- 
 national conference at Mukden, under Wu-Tien-Leh, 
 whom as Dr. Tuck I met at work in the Malay States 
 (see p. 107), has been unable to decide what part, if 
 any, has been played by the tarbagan, the common 
 Manchurian rodent. The channel of infection in 
 pneumonic plague the form we in England have most 
 to fear is still in doubt, and until that is settled, 
 systematic and certain prevention is impossible. 
 
 A single striking discovery of world-wide import- 
 ance, like that of Ross concerning malaria, suggests 
 to observers throughout the world its applicability 
 to other diseases. The pioneers of medicine, more 
 especially those inspired by tropical work, are trying 
 their utmost to prove or disprove the part played 
 by insects the " intermediate hosts," as they are 
 called in the transmission of every infectious dis- 
 ease known. The essential part played by such 
 intermediate hosts has been proved in the case of 
 yellow fever, transmitted by a different variety of 
 mosquito ; in that of sleeping sickness, transmitted 
 by one form of the tsetse fly ; in those of rinderpest, 
 surra, Texas fever, and several other devastating 
 diseases of horses and cattle ; and now in that of 
 bubonic plague. The analogy in the case of other 
 
98 HEALTH AND EMPIRE 
 
 diseases is too tempting to be lightly dismissed. Dr. 
 Hunter's work at Hong-Kong was a fine example 
 of the official encouragement of research. In most 
 cases in Hong-Kong in which the cause of death 
 was not certified by a medical practitioner on the 
 colonial medical register, the body was taken by 
 the police to the government mortuary ; and as 
 there were but few Chinese names on the medical 
 register, and a large proportion of the population 
 was Chinese, 2326 bodies were thus examined during 
 the year prior to my visit out of 4905 deaths, re- 
 quiring an examination therefore of as many as 
 30 bodies a day. This is probably an unrivalled 
 opportunity for good post-mortem work, not least 
 with a view to the study of plague. In addition to 
 these examinations, others included in the above 
 total of deaths were examined at the mortuary 
 across the harbour in Kowloon ; 101,056 rats were 
 examined bacteriologically ; a cattle disease was in- 
 vestigated and found not to be true rinderpest ; and 
 7074 tubes of smallpox vaccine were prepared during 
 the year. The government had built Dr. Hunter a 
 good bacteriological laboratory, and have since then 
 built a good mortuary at Kowloon. The former, 
 recently enlarged, was large enough even for these 
 wider purposes, and well arranged ; and there was a 
 good staff of assistants, some of whom were qualified 
 to do the bacterial work themselves under the general 
 control of the bacteriologist. 
 
 The value of research work is tested, not by the 
 accuracy of the theories appended to it, but by the 
 general quality and direction which it displays. A 
 
THE FLEA 99 
 
 good director is constantly asking himself questions 
 and shaping the work of his laboratory to give him 
 the answers. The answers given are at first mere 
 rumours, which must be tested again and again, until 
 the verdict is given, full and unmistakable ; like the 
 chorales of an oratorio, summing up the previous 
 numbers, given out on the full organ, and joined in by 
 the whole congregation. 
 
 So the rat-flea theory of the transmission of plague 
 has in six years gained acceptance throughout the 
 world, established not least by the well-grounded but 
 intermediate opposing theories of the government 
 laboratory at Hong-Kong. After some years of un- 
 just suspicion and short-sighted treatment M. Haff- 
 kine has returned to service under the Indian govern- 
 ment, working in the original research laboratory of 
 the English hospital at Calcutta. India is likely to 
 reap a rich harvest from his genius and his thoughtful, 
 persevering humanity ; while the Indian government 
 deserve the utmost credit for retracing a wrong step, 
 taken under sore trial, and for securing again their 
 chief scientific asset. The government of Hong-Kong 
 no less may still boast of their provision for research, 
 may well honour the memory of Dr. Hunter's sterling 
 work, and may justly be held up for an example in 
 the encouragement of research that should have been 
 followed many years ago by every government, auton- 
 omous or maternal, throughout our empire. 
 
 Had such provision been made on a business footing 
 twenty years ago, millions of deaths and treasure 
 beyond value would have been saved through speedy 
 determination even of the Indian plague alone. 
 
CHAPTER V 
 
 BERI-BERI 
 
 A RESEARCH INSTITUTE, surpassed in importance 
 by none throughout the empire, is that at Kuala 
 Lumpur, the capital of the Federated Malay States. 
 It was founded in 1900 by the government of those 
 states with a view to the investigation of beri-beri, 
 a disease which has caused a very great loss amongst 
 Chinese and Indians, especially in the Straits Settle- 
 ments, in China and in Japan. This disease, first 
 mentioned in a Chinese work in 200 B.C., and in a 
 Japanese medical treatise in the ninth century, was 
 brought by the Dutch to European notice in the early 
 years of their East Indian history, and studied later 
 in India and more recently in Brazil and Japan. It 
 is now one of our imperial problems. Singapore and 
 Kuala Lumpur are good fields for the purpose of 
 studying this disease. In the Pauper Hospital at 
 Singapore in 1904 were no fewer than 260 cases 
 amongst the 600 inmates ; and for some years past 
 between 1000 and 2000 cases had been admitted to 
 hospital every year in Singapore. What is this 
 imperial problem ? And, first, what is the nature of 
 the scourge ? 
 
 Beri-beri or, in Japanese, kakke, consists of a 
 paralysis of the limbs, more especially of the legs, due 
 
 100 
 
BERI-BERI 101 
 
 to an inflammation of the nerves (peripheral neuritis) , 
 complicated by dilatation and weakness of the heart, 
 and in many cases by dropsy. According as there is 
 or is not dropsy, the case is called one of " wet " or 
 " dry " beri-beri. This affection of the limbs is very 
 similar to that which occurs as a late symptom of 
 severe diphtheria, or an occasional sign of continued 
 alcoholic poisoning ; indeed, it was always considered 
 a direct result of alcoholic poisoning until an out- 
 break in Manchester was investigated in 1900. 
 
 It will be remembered that some stir was caused 
 by the discovery that the Manchester cases were due 
 to poisoning by arsenic contained in beer that had 
 been drunk by the sufferers ; and the preparation 
 and examination of the malt employed in brewing 
 processes had to be fundamentally revised. But 
 beri-beri is certainly not due to the drinking of beer, 
 arsenically tainted or otherwise, for, as a rule, the 
 Chinese and Malays are not beer-drinkers. A mer- 
 chant captain in Singapore told me that he and his 
 chief officer, both of them teetotalers, once had the 
 disease in a mild degree when they were carrying an 
 infected crew. Beri-beri is due to a different poison. 
 
 It is the scourge of many of the mines and planta- 
 tions of the Malay Archipelago. An island taken 
 over by a telegraph company, for the establishment 
 on it of a telegraph station, was previously but little 
 inhabited, and certainly not suspected of harbouring 
 any pestilence. Some 700 coolies were imported for 
 the labour that was required, but within a few 
 months half their number were down with beri-beri, 
 and the work had to be stopped and the island for a 
 
102 HEALTH AND EMPIRE 
 
 time abandoned. The disease is apt to break out 
 among coolie gangs engaged on plantations in the 
 East Indian islands or on extensive engineering works 
 in the tropics, such as the railway in the Belgian 
 Congo ; it haunts the Dutch army in Sumatra ; in 
 former days, until better conditions of health were 
 obtained, it was common enough amongst British 
 troops in India ; it frequents Brazil in the Far West 
 and Japan in the Far East ; out of the first 1000 
 Chinese coolies imported to South Africa in 1904 
 there were over 60 who developed the disease during 
 the voyage from China ; and in Calcutta it seldom 
 occurs except amongst the Chinese. 
 
 Kakki was rife in the early days of the modern 
 Japanese navy. It was stamped out by Dr. (now 
 Baron) Takaki, who at the age of twenty-eight, having 
 obtained his medical education at St Thomas's 
 Hospital and his Fellowship of the Royal College 
 of Surgeons, was made Director-General of the 
 medical service of the Japanese navy. He resolutely 
 set to work to inquire into the cause of the disease. 
 The rice diet was impugned ; the diet accordingly 
 was changed, and beri-beri became almost as extinct 
 in the Japanese as it is in the British navy. The 
 cause then, said Dr. Takaki, lay in the rice. But this 
 conclusion was stoutly disputed. While Dr. Takaki 
 was inquiring into the causes of beri-beri, did he 
 stand still as regards the other conditions affecting 
 the health of the Japanese sailor ? Certainly not. 
 He set himself assiduously to improve the conditions 
 affecting their health in all respects, and it might be 
 any one of those improvements, concurrent with the 
 
BERI-BERI 103 
 
 change of diet, that effected the stamping out of the 
 disease. Let anti-vaccinationists listen. 
 
 The death-rate from beri-beri on Christmas Island, 
 where the science of tropical diseases in 1902 
 suffered an irreparable loss in the death of young 
 Patrick Manson, had in 1904 gone down from 90 to 
 45 per 1000 in two years, and in Singapore the sea- 
 side treatment, in simple attok or grass huts, had 
 been most successful. 
 
 An experiment, considered crucial at the time, was 
 made twenty years ago in the lunatic asylum at 
 Singapore to test the share of rice in the causation 
 of the disease. Twenty healthy lunatics on admis- 
 sion were separated from the rest in two cottage 
 blocks. For some years there had been a good deal 
 of beri-beri, which the authorities were unable by 
 any means to stamp out. These twenty healthy 
 patients were fed on European food without rice, 
 but in six months half of them showed symptoms in 
 greater or less degree of beri-beri. Surely then rice 
 was not an essential factor in the disease ; the soil 
 and buildings were infected. It was necessary 
 therefore to remove the patients to fresh soil and 
 surroundings. To attain this object the patients 
 were sent to wards by the seaside at Pasir Panjang. 
 They bathed once or twice daily in the sea, and then 
 were massaged ; their clothing was changed, dis- 
 infected and washed twice a week ; beds, bedding, 
 walls and floors were washed and disinfected with 
 perchloride of mercury weekly ; the sand of their 
 compound was scraped up weekly to a depth of two 
 inches, and exposed in baskets to one tide of the sea 
 
104 HEALTH AND EMPIRE 
 
 and to the sun before being replaced ; and their 
 plates and utensils were disinfected with perchloride 
 twice a week ; but the diet was the same as at the 
 lunatic asylum, with rice, and with only tea to drink. 
 The result of this move is shown by these figures : 
 
 .r Average No. Beri-beri ^ ., 
 
 Year Resident New Cases Deaths 
 
 1900 180 153 51 
 
 1901 164 102 15 
 
 1902 174 99 4 
 
 The four deaths in 1902 were those of patients who, 
 on account of overcrowding, had to be kept under the 
 old conditions in the former asylum ; the new con- 
 ditions had absolutely stamped out the fatal form 
 of the disease, despite the continued use of rice. The 
 experiment was suggestive, but on too small a scale 
 to eliminate possible errors. The patients officially 
 deprived of rice might possibly have obtained it 
 nevertheless, or might have had the disease on them 
 from the first. The effect of sea-bathing and massage 
 only proved the power of a healthy body to overcome 
 disease. And so between 1904 and 1906 the patients 
 were kept on cured or uncured rice alternately ; the 
 disease disappeared entirely when the rice was cured, 
 reappeared when it was uncured ; in 1906, on cured 
 rice only, there was not a single case of the disease. 
 
 The late director of the government research 
 institute at Kuala Lumpur, Dr. Hamilton Wright, 
 of McGill University, Toronto, had recently issued a 
 full report as the result of his investigations on the 
 subject. Both Wright and his successor, Dr. Daniels, 
 believed that the disease was due to a parasite, just 
 
BERI-BERI 105 
 
 as diphtheria is due to a definite bacillus, and that 
 the paralysis both of beri-beri and of diphtheria were 
 due to the poisons formed by the respective bacilli. 
 Wright however went further, and believed he had 
 found the breeding-place, the primary seat of this 
 disease within the body, corresponding to throat and 
 tonsils in diphtheria. Unfortunately beri-beri is a 
 very chronic disease, and, by the time that cases could 
 be examined post-mortem, Wright maintained that 
 the primary stage of the disease had passed away. 
 This primary stage he believed to be an inflammation 
 of the intestine at its opening from the stomach 
 the duodenum suggested by a pain in the pit of the 
 stomach of which patients in an early stage often 
 complain. He found a little evidence of some such 
 inflammation in his examinations after death. 
 Hunter at Hong- Kong bore out these observations, 
 but they are not accepted by general opinion in 
 tropical medicine. 
 
 On the other hand Drs. Eraser and Stanton, work- 
 ing more recently at Kuala Lumpur, have lately 
 summed up the evidence in favour of Braddon's 
 original view in the medical archives of the Federated 
 Malay States for 1901, that, for some reason or other, 
 the disease is commonly caused by white rice. The 
 medical officer of health at Bangkok has lately 
 declared that the disease can be prevented and in 
 most cases actually cured by the substitution of par- 
 boiled for white rice. 
 
 It appears that the white, polished rice has in 
 the process of polishing lost some substance essential 
 for the nutrition of the nerves and associated with 
 
106 HEALTH AND EMPIRE 
 
 phosphorus in a constant proportion. That sub- 
 stance may be merely a simple compound of phos- 
 phorus ; but the practical point is that a diet of 
 polished rice is insufficient to prevent the disease ; 
 add the polishings, or give only the whole rice, and 
 the disease may be both prevented and cured. The 
 enthusiasts for standard bread may draw a moral 
 from the analogy. 
 
 Beri-beri, then, is a disorder of nutrition ; it is 
 probably not bacterial in origin ; it is probably not 
 infectious. 
 
 One's first experience of beri-beri in comfortable 
 beds and spotless linen in the fine wards of that 
 worthy imperial institution the London School of 
 Tropical Medicine at the Albert Docks gave little 
 idea of the true extent of the disease in all its gravity. 
 
 Such an idea was given in an afternoon's visit to 
 the Singapore hospital, especially by a parade of the 
 convalescent cases for my inspection a melancholy 
 march of cripples, dragging their legs behind them 
 and shuffling along with the help of sticks and 
 crutches. It is there on the spot, with abundant 
 material for investigation, that ample investigation 
 should be conducted ; and yet there in Singapore not 
 a single man has leisure or opportunity, in the 
 multitude of his existing duties, for the purpose. 
 
 It is idle to retort that at Kuala Lumpur, in a better 
 climate, there is such an institute established specially 
 for the purpose. If we only realised the true import- 
 ance of setting ourselves with determination to dis- 
 cover the remedy for this scourge we would double 
 the staff at Kuala Lumpur, and we would also 
 
BERI-BERI 107 
 
 establish a good research laboratory, properly 
 equipped and staffed, at the expense of the imperial 
 government, at Singapore. The disease is imperial 
 in distribution and importance, demanding closer 
 attention than has yet been given it by the authori- 
 ties, and isolated colonies cannot be expected to pay 
 for imperial research. 
 
 The staff at Kuala Lumpur consisted of the 
 director, his assistant, Dr. Lester, and a young China- 
 man, Dr. Tuck, a truly scientific and zealous worker, 
 with a travelling fellowship from Emmanuel, Cam- 
 bridge, whither he had been sent by the government 
 of Hong-Kong with a Victoria Scholarship of 250 a 
 year for five years. It is this Chinese sage Dr. 
 Tuck, alias Wu-Tien-Leh who in April, 1911, has 
 been presiding over the international plague con- 
 ference in Mukden, and whose presidential address, 
 published in The Lancet of ist May, shows his width 
 of view. 
 
 The laboratory, on a good site, a mile outside the 
 town, was well fitted up, the apparatus including 
 various costly novelties devised by the first director, 
 an ingenious Canadian such, for instance, as the 
 stereoscopic, binocular, beetle-trap microscope, which, 
 like most ingenious novelties, was not in use. The 
 purpose of the institute was in the first place to 
 investigate beri-beri ; but its aims were soon 
 enlarged, and in 1904 Dr. Daniels was providing 
 facilities for investigation into all phenomena of 
 disease by officials of any government department 
 concerned with live stock, whether animal or vege- 
 table. In the insectorium, kept at a fearful heat and 
 
108 HEALTH AND EMPIRE 
 
 saturated with moisture for the purpose, the director 
 showed me, for instance, a sugar-cane invaded not 
 by a beetle but by a boring butterfly larva, which 
 made way for the entrance of destructive red ants, 
 and these in nature would promptly make an end of 
 that shoot of sugar-cane. He showed me the sheds 
 and enclosures for cattle under investigation in 
 connection with rinderpest, and experimental planta- 
 tions of rubbers, sugar, coffee, grains and fruit-trees, 
 for research into diseases of plants by the forest 
 department. 
 
 The direct commercial value of such an institute 
 at the present time can hardly be exaggerated. It 
 is extraordinary how new ideas come to the worker in 
 human disease from the consideration and observa- 
 tion of disease in animals and plants. For practical 
 purposes it may not be well to add this or any other 
 subject to the medical curriculum at home, but in 
 academic centres and for purposes of academic 
 research it is worthy of serious consideration whether 
 a brief account of comparative animal and vegetable 
 pathology, and some practical experience of a her- 
 barium and a veterinary hospital, might not with 
 advantage be included in the course of those seeking 
 the higher medical degrees. The theory of medicine 
 ought not to be confined to a study of disease in man ; 
 and such an extension of the field of view would be 
 likely to throw considerable light on the nature of 
 many diseases which it is absurd to suppose can be 
 unravelled from a consideration of their effects in one 
 single species of the animal kingdom alone. 
 
CHAPTER VI 
 
 " SEEK AND YE SHALL FIND " 
 
 IT is easy enough to state the magnitude of imperial 
 problems, to set the world aghast at the dangers 
 they suggest and to call aloud for help. But to give 
 help requires knowledge of the cause and site of the 
 trouble, followed by the invention of a remedy. 
 
 It must be agreed that investigation of any disease 
 should go on in as many quarters of the world as 
 possible in order to understand its behaviour under 
 varying conditions of climate, race and habit ; that 
 the work should run on comparable lines, should be 
 continuous, and, above all, effective. Under proper 
 organisation, the imperial authority would subsidise 
 research work in every dominion and colony, requir- 
 ing certain conditions in return for the grant made 
 and linking up the whole into one system with inter- 
 changeable personnel and a graded remuneration, 
 sufficient to attract and retain men and women of 
 ability. Many women are well suited for research. 
 
 In the hope that some such proposal may before 
 long be considered by the imperial authorities it may 
 be as well to give some account, in addition to that 
 already given, of the spade-work being carried on in 
 isolation in laboratories farther east. Much ground, 
 fresh and old, is being constantly turned over, and 
 109 
 
110 HEALTH AND EMPIRE 
 
 every now and again some glint of precious know- 
 ledge is descried, to be passed through the clearing- 
 house of science, credited to the account and cashed 
 when sufficient to meet the creditors who press on 
 every side. Systematic research will increase the 
 effective output of our laboratories a hundredfold. 
 
 Some account has already been given of the 
 research establishments at Parel and Kasauli in 
 India and at Kuala Lumpur in the Federated Malay 
 States. 
 
 The next research institute visited was that 
 established in the French colony of Cochin-China. 
 The great Hopital Militaire of Saigon is a general 
 hospital of five hundred beds or so, including an 
 infectious block, and is managed by the military 
 doctors. In its compound stands a separate block, 
 the Pasteur Institute of the far east, founded as a 
 direct descendant of the parent institute in Paris. 
 M. Metin, the distinguished director, was at home on 
 furlough. Himself a medecin major de la premiere 
 classe, his adjoint Dr. Brau ranked as a captain, and 
 the staff was completed by M. Breaudat, pharmaceur 
 major, deuxieme classe, troupes coloniales. Their 
 actual equipment for research, as regards special 
 incubators, autoclaves and appliances, was superior 
 to that at Kasauli, but their rooms were not com- 
 parable. They had nothing like Colonel Semple's 
 new laboratory or stable ; they had only one rather 
 small block, and there was little ground at their dis- 
 posal. But the charming part of scientific research is 
 that its value depends almost entirely on the worker, 
 and hardly at all on his apparatus ; by far the chief 
 
"SEEK AND YE SHALL FIND" 111 
 
 requisite is scientific material, and of that they have 
 plenty both at Kasauli and at Saigon. 
 
 This institute, founded in 1890 or earlier for the 
 treatment of rabies, was reorganised in 1901, and its 
 work in the following year included (a) the prepara- 
 tion of over 2,000,000 doses of vaccine ; (b) the treat- 
 ment of 67 cases of rabies ; (c) the preparation or 
 distribution from Paris of antitoxic sera for snake- 
 bite, tetanus, diphtheria, blood-poisoning and 
 plague ; (d) disinfection of infected clothing ; (e) bio- 
 chemical analyses and researches of a stimulating 
 order on such things as manures, indigo and the use- 
 less, imputrescible and almost incombustible paddy- 
 husk ; (/) scientific examinations into material from 
 the hospital ; and (g) researches on dysentery, on 
 beri-beri (with the usual negative result) and other 
 tropical diseases. The bacterial work included the 
 investigation of Metin's cocco-bacillus of dysentery. 
 
 Vaccination has had such a striking effect, and has 
 been so widely adopted in all Eastern countries ruled 
 over by Europeans, that we are inclined to forget the 
 extreme gravity of the scourge which it has to a 
 large extent stamped out. Indeed it is not only in 
 European-governed countries that vaccination has 
 been adopted. The Coreans for instance decided some 
 ten years ago to institute a service of vaccination, 
 but they did it in their usual lackadaisical way. 
 They instituted half-a-dozen vaccination stations 
 throughout the country, fairly well equipped, at 
 least with vaccinators ; but my own informant, a 
 Japanese naval doctor at the head of the Japanese 
 civilian hospital at Seoul, assured me that not a single 
 
112 HEALTH AND EMPIRE 
 
 inoculation was ever done ; the money simply 
 evaporated. 
 
 In French Indo-China, however, the process has 
 been properly systematised, and in 1903, 318 buffalo 
 calves were hired during the year to produce the 
 2,000,000 doses, more than a quarter of which were 
 exported, chiefly to Singapore and Hong-Kong. 
 The system of hiring the buffalo calves is to be com- 
 mended on the score of expense. They are hired 
 when two years and a half old, for two Mexican 
 dollars (45.) a week, plus transport. Brought into 
 the institute on a Tuesday, they are inoculated by 
 the lymph which has given the best human results 
 on Wednesday, and the pustules squeezed dry with 
 la pince chambon (pincers perpetuating the honour of 
 their inventor) on the following Monday. The calf 
 is then returned to its owner. The pulp from the 
 pustules is mixed with lymph and glycerine in pro- 
 portions of five, one and three, and gives remarkably 
 good and constant results, 94 per cent, of the primary 
 vaccinations being successful, while, when performed 
 at the laboratory itself, over 99 per cent, are success- 
 ful. To show the value of precautions such as are 
 taken by the laboratory staff in securing proper 
 results, it may be mentioned that revaccinations in 
 general proved effective in only 5 per cent, of the 
 cases, but, when performed in the laboratory, in 
 37 -5 per cent. revaccination in the laboratory was 
 seven times as successful. Vaccination is performed 
 by the various medecins des posies ; and for purposes 
 of organisation Cochin-China is divided into eastern 
 and western divisions, each being toured over by a 
 
"SEEK AND YE SHALL FIND" 113 
 
 single vaccination officer, under the Chef du Service 
 de Sante. The Pasteur Institute would like to carry 
 out the vaccination themselves, with two extra men 
 to help them, and believe it would then be far more 
 effective ; for it should always be a principle, hitherto 
 very seldom recognised, that research work and 
 administration should go hand in hand. It is absurd 
 in any branch of life to divorce theory from practice, 
 and we at home are blatant sinners in this respect. 
 
 For the treatment of rabies 135 patients presented 
 themselves, but only 67 were treated, the remainder 
 being acquitted from danger by the incriminated dog 
 not dying within six days. It is found that rabies can 
 only be given by a dog within three days of its death 
 from the disease. This fact of its death is the only 
 diagnostic method of any use ; for if the dog be 
 killed and its head sent up for examination, char- 
 acteristic lesions are seldom found under the micro- 
 scope ; and inoculation on the other hand takes too 
 long, as it is a fortnight before a guinea-pig shows 
 signs of the disease. At Kasauli they commence 
 treatment without waiting for the verdict of the 
 inoculation experiment ; at Saigon no treatment is 
 given for three days, and thereafter only if the sus- 
 pected dog has died during this interval. This delay 
 certainly saves half the patients from unnecessary 
 treatment, but time is of vast importance in virulent 
 cases, and it may be due to this delay that two cases 
 were lost at Saigon in 1903, as symptoms began 
 respectively on the eighteenth and twelfth days of 
 treatment. It would seem best to combine the two 
 systems in vogue at Kasauli and Saigon ; to com- 
 
114 HEALTH AND EMPIRE 
 
 mence treatment in all cases at once ; to keep the dog 
 alive under observation at all costs, in order to see if 
 he dies within the three days ; and in all cases to 
 perform the control inoculation experiment upon a 
 guinea-pig. Of course at Kasauli, a distant hill 
 station reached only in most cases by a long train 
 journey, it would be impossible in most cases for the 
 dogs to be sent with the patients ; but they might 
 quite well be kept at police-stations under the super- 
 vision of the local civil-surgeon, who could easily 
 certify as to their death, and wire it to Kasauli. It 
 is certainly a remarkable result in twelve years to 
 have treated 689 certain cases at Saigon, with only 
 13 deaths. 
 
 As further evidence of the value of the Saigon 
 institute, and of the cosmopolitan outlook of hospital 
 work, it was interesting in Tokyo to meet with a 
 young Scotsman, who had been bitten by a mad dog 
 up in the Shan States, and had journeyed down with 
 all possible speed to Saigon, where he had been success- 
 fully treated. It is difficult for those who have never 
 been in uncivilised countries to realise the solid com- 
 fort represented by an assurance that such treatment 
 is available. Such evidence goes far to modify the 
 terrors of the exile and the dangers of pioneer work 
 on the outskirts of our empire. 
 
 As to the disinfection of infected clothes, which is 
 performed by the Pasteur Institute for the whole 
 town, it is curious to find the discredited sulphur still 
 in use in cases where steam under pressure is unsuit- 
 able. Sulphur, it has been found, and is not, I 
 think, disputed, is only effective in killing insects and 
 
"SEEK AND YE SHALL FIND" 115 
 
 larger animals, and never in killing the germs of 
 disease. Fumigation by sulphur lives on in England 
 only because of its unpleasant smell, which makes 
 the laity realise that something is certainly being 
 done. 
 
 In his researches into the causation of tropical 
 disease, M. Brau had reached an interesting stage 
 with regard to cholera. By growing the cholera 
 bacillus on a blood medium in a bottle, and inoculating 
 dogs with the culture, he was able from the dogs' 
 blood to recover the cholera poison increased in 
 virulence. He thus claimed to have obtained a 
 cholera toxin of fixed strength, and hoped in the next 
 stage, by injecting this fixed toxin into a dog in 
 increasing strengths, to immunise him against the 
 disease, and so prepare from his blood an antitoxin. 
 Since then he has by a modified method succeeded 
 in preparing a trustworthy antitoxin for the cure of 
 cholera, in addition to the prophylactic first made by 
 Haffkine for prevention of the disease. 
 
 One of the most famous of modern bacterio- 
 logists lives also in Indo-China, about a day's journey 
 up the coast, but works independently of the Pasteur 
 Institute, in a private laboratory of his own. M. 
 Yersin is chiefly known for the fact that he and 
 Kitasato, the Japanese authority, were both invited 
 by the government of Hong-Kong to come over and 
 help them at the outset of the present epidemic of 
 plague in 1894. The plague bacillus was first dis- 
 covered by both men independently within a few 
 days of each other. The credit of the description 
 belongs primarily to Yersin. Yersin now prepares 
 
116 HEALTH AND EMPIRE 
 
 an antitoxic serum for the actual treatment of cases 
 of plague. This in theory would be a great improve- 
 ment on Haffkine's vaccine, for the vaccination can 
 only gradually stimulate the body to produce an anti- 
 dote, ready to meet any subsequent attack ; the 
 antitoxin already prepared is itself the antidote, and 
 may be administered as a medicine at any stage of 
 the disease. Moreover, the Asiatic native does not 
 care to submit to precautionary measures. Un- 
 fortunately for research, there had been no plague 
 in French Indo-China on which to try Yersin's new 
 serum. Yersin's former serum, which he tried in 
 India, was, comparatively speaking, a failure ; but 
 it appears that in India Yersin experienced much 
 difficulty from his non-observance of the proper 
 customs and formalities. His serum is now said to 
 be useful at least for Europeans, who show a lower 
 fatality, except in pneumonic plague, and are said to 
 have a greater power of resistance than Asiatics 
 although this difference again may be merely due to 
 better notification of mild cases in Europeans. 
 
 Leprosy plays a considerable part in the life of the 
 French colony, and in the researches therefore of the 
 Pasteur Institute at Saigon. The sages were trying 
 to prove that the bacillus had its primary seat in the 
 nerves ; such a fact, if proved, would obviously be the 
 starting-point of observations and methods which 
 might lead to a real cure of this at present most 
 extensive and incurable disease. A charming young 
 savant had been working voluntarily, both up- 
 country and at Saigon, on the kindred disease named 
 yaws, a very chronic but infectious eruption on the 
 
skin, which occurs extensively throughout the greater 
 part of the tropical world. This genial, soft-bearded 
 devotee of science was out there at his own expense. 
 He had recently translated Hanson's " Tropical 
 Diseases " into French, and was just going to England 
 to take out a course at the London school. 
 
 The work of the institute is reported in full in the 
 official Annales published by the French Colonial 
 Office, a modest but most interesting little periodical. 
 It is to be wished that our Colonial Office might con- 
 descend in this respect to follow the lead of Germany 
 and France, and publish a similar official digest of 
 the vastly important material in matters of tropical 
 medicine and sanitation that are constantly coming 
 to their hand. As it is, I believe the reports go down 
 to the library of the School of Tropical Medicine at 
 the docks, and are decently interred in glass book- 
 cases, without even so much as a catalogue to record 
 their last resting-place. Here is a vast field of 
 material wasted. 
 
 The Journal of Tropical Medicine, published every 
 month, gives an abstract, one by one, of the colonial 
 reports ; but these reports, to be made valuable and 
 available to every sanitary administration in the 
 empire, require careful collation and comparison 
 in the light of experience, as can only be done 
 in a government office, year by year. The annual 
 report of the medical officer to our Board of Educa- 
 tion forms an admirable and most useful precedent. 
 
 Without complaining, for the empire is young and 
 the imperial sense is still younger, it is well to call 
 attention to the latent privileges and opportunities 
 
118 HEALTH AND EMPIRE 
 
 afforded us by our empire ; our first duty and 
 interest should be to catalogue them ; and so to 
 classify, digest and publish to the world in a palat- 
 able form the extensive information we have of 
 imperial dangers, the methods with which to meet 
 them, and the work done to devise new safeguards, 
 new methods of action, in a department of imperial 
 life so important as that of health. 
 
 The main impression of the visit to the Pasteur 
 Institute at Saigon was, as my French friends said, 
 that " there is no nationality in science," that the 
 true research worker has a fine game to play, and 
 that he plays it well. The same was the experi- 
 ence of visits to similar institutions at Shanghai and 
 Tokyo. 
 
 The municipal laboratory at Shanghai is a smaller 
 affair, under the supervision of the British Health 
 Officer, Dr. Stanley, my fellow-traveller to Aden in 
 the previous year, trained and well known in the 
 London schools. The laboratory is well built in red 
 brick, and is the property of the municipality, which 
 represents fifteen different nations in the foreign 
 quarter of Shanghai. Matters of public health are 
 evidently considered the domain of our race, and as 
 an example of what may be done by energy, with 
 little material and still less encouragement, this 
 laboratory deserves a notice. 
 
 The preparation of vaccine is again one of their 
 chief operations. I found the calves putting their 
 noses round the corner in the yard, prior to being 
 scraped, slaughtered, and examined post-mortem as 
 a guarantee of their health. In a recent year, of 
 
"SEEK AND YE SHALL FIND" 119 
 
 which Dr. Stanley has sent me his annual report, 
 60,000 doses of vaccine were issued ; against the 
 plague 615 doses of Haffkine's prophylactic were 
 made ; antitoxins against glanders, tuberculosis, 
 diphtheria and cholera were being prepared ; and 
 47 persons had been treated for rabies, without a 
 failure 268 persons had been so treated up to the 
 end of 1909. It was interesting to find that the 
 rabbits inoculated with emulsion of an infected 
 brain died here on the tenth to the fourteenth day ; 
 in Paris on the fourteenth to the twenty-first ; and 
 at Kasauli on the eighteenth to the twentieth. 
 Rabies in mid-China is evidently of exceptional 
 virulence. All the apparatus was very complete, 
 modern and efficient ; there was a good staff of 
 assistants ; and Drs. Stanley and Moore, besides 
 doing necessary sanitation work, analysing in the 
 year 31 samples of water and 383 of milk and 
 examining 18,265 medical specimens, were able to 
 spare a little time to research. 
 
 In Tokyo the Institute for Infectious Diseases is, 
 somewhat unexpectedly, an example, in the first 
 instance, not of government foresight but of private 
 generosity and patriotism. In 1891 Professor Kita- 
 sato, on his return from Berlin, where he had served 
 a memorable apprenticeship under Koch and, with 
 Von Behring, had worked out the tetanus and 
 diphtheria antitoxins, was considering a plan of 
 devoting himself to the investigation of infectious 
 disease. A Japanese gentleman named Fukuzawa 
 at once volunteered to give him financial aid by 
 erecting a new laboratory and paying for its main- 
 
120 HEALTH AND EMPIRE 
 
 tenance. The Emperor, however, had already given 
 Kitasato a scholarship, to encourage him to con- 
 tinue his investigations in Germany, and the Japan 
 Private Hygiene Association decided therefore to 
 establish an institution for the purpose in the country. 
 Mr. Fukuzawa presented them with the free use of the 
 building he had constructed, and the land on which 
 it stood. The institute, under the auspices of the 
 association, was opened on 30th November 1892, 
 with Kitasato as its president. Funds for the work 
 were subscribed by several persons, both foreign and 
 Japanese, but, being inadequate, were supplemented 
 three months later by a government grant of 20,000 
 yen (2000) for building purposes, and 15,000 yen 
 (1500) per year for expenses for three years. The 
 present building was therefore erected, and com- 
 pleted in 1894 ; the grant for maintenance was 
 renewed in 1896 ; and in 1899 it was made a national 
 establishment. The Budget for the year 1903 was 
 48,518 yen (about 4850). 
 
 The work of this institute is divided into three 
 departments. In the first Professor Kitasato attends 
 to all matters relating to research as to the causes of 
 infectious and other diseases, and their prevention ; 
 in the second he superintends the hospital, and has 
 the control of all routine bacteriological examina- 
 tion ; in the third he investigates methods in use 
 for prevention of disease, disinfection and treatment, 
 and the arrangement of courses of instruction. Each 
 department has its separate head, with so many 
 assistants respectively attached to them. Many 
 physicians from the schools of different prefectures, 
 
"SEEK AND YE SHALL FIND" 121 
 
 and many medical officers in the army and navy, with a 
 few foreign visitors, study bacteriology in the institute. 
 
 The institute is of course built on European lines. 
 The library, for instance, into which the visitor is 
 first shown, might be a well-equipped example of 
 any such library in Germany, with an incongruous 
 bronze bust of the president, in European style, on a 
 marble column. This bust, much as it may shock 
 artistic feeling, was presented to Professor Kitasato 
 on his return with Professor Oyama from his note- 
 worthy visit to Hong-Kong in 1894, under the com- 
 mission of the Japanese government, to study the 
 plague. On the ground floor is also the chemical 
 laboratory ; on the first floor are two large and six 
 small laboratories for research and for the general 
 work of the institute ; while in an adjacent building 
 is the students' training-hall, with a lecture-room for 
 150 persons, and a long laboratory. Other neigh- 
 bouring buildings include two for a hospital, a 
 photographic building, a dissecting building and a 
 house for the animals kept for purposes of experiment. 
 For the latter object, however, large animals, par- 
 ticularly for the purpose of experiments with anti- 
 toxin, are kept in a large stable, two miles away, with 
 accommodation for twenty horses. 
 
 In consequence of the share taken by Kitasato in 
 the discovery of the antitoxins for diphtheria and 
 tetanus, these two subjects naturally take the first 
 place in the report of the institute, and in ten years 
 nearly 5000 cases of the first and 74 of the second 
 disease were treated, with the low mortality respec- 
 tively of 10 and 55 per cent. 
 
122 HEALTH AND EMPIRE 
 
 Much work again is done, according to Pasteur's 
 methods, for inoculation against hydrophobia. In 
 six years 428 persons came for treatment ; only one 
 of these, a Russian, was a failure. When cholera 
 broke out in Japan in 1895, as a direct result of the 
 war with China, Kitasato undertook the care of the 
 city hospital, specially established for this disease, 
 and first tried the inoculation of antitoxic serum. 
 Of the patients thus treated, 33 per cent, died, while 
 of those not so treated 70 per cent. died. In 1902 
 cholera again prevailed ; patients were treated with 
 antitoxic serum, while a sufficient quantity of 
 cholera vaccine was prepared for the use of 2,000,000 
 persons, and distributed for preventive purposes. 
 The statistical result of this method of prevention is 
 not forthcoming ; that of the treatment of patients 
 by serum shows a death-rate of 51 per cent. As I 
 have said, in speaking of similar work at Saigon, this 
 treatment is at present in a very early stage, but 
 offers abundant scope for development. 
 
 The chief triumph of this institute in original 
 work is in connection with dysentery, prevalent in 
 Japan and other countries of the temperate region to 
 a serious extent. Whereas the dysentery of the 
 tropics is caused by an amoeba a small parasite, 
 looking under the microscope like a drop of jelly 
 and commonly gives rise to abscess of the liver, the 
 dysentery of Japan, which is not associated with liver 
 abscess, was discovered in 1897 by Dr. Shiga, formerly 
 chief of a department in this institute, to be due to 
 what is now called " Shiga's bacillus," resembling 
 to some extent the bacillus of typhoid fever. The 
 
"SEEK AND YE SHALL FIND" 123 
 
 further most important discovery was made that an 
 antitoxic serum derived from this bacillus was an 
 exceedingly effective remedy. The results of its use 
 in the last few years have given a death-rate of from 
 9 to 12 per cent, as against 30 or 40 per cent, under 
 ordinary treatment. The method is also used 
 throughout Japan, far away from Tokyo, with most 
 satisfactory results. 
 
 Furthermore, Shiga devised a method, similar to 
 that used by Haffkine for the plague and similar 
 to that used for cholera, as a preventive inoculation 
 against dysentery. In August, 1900, dysentery broke 
 out at Koai, a little village in the prefecture of 
 Kanagawa, and twenty-eight persons were attacked 
 within the month. Thereupon all persons in the 
 village over four years of age were required to be 
 inoculated compulsory measures, be it noted. 
 Except for two cases which occurred on the first day 
 after inoculation, not another case followed. 
 
 Similar methods were in active use against typhoid 
 fever, erysipelas, plague, and bites from the most 
 poisonous " habu " snake. This poison is of such 
 intensity that one gramme will kill 1000 rabbits, 
 and one-tenth of a gramme will kill a horse. Three 
 hundred human cases of bite from this snake occur 
 on an average every year, and the mortality is gener- 
 ally one in seven. The use of the serum as a remedy, 
 and the immunisation of cattle, horses and sheep, 
 are both in their infancy, and offer a most hopeful 
 prospect. 
 
 The use of the serum prepared against the plague 
 in Tainan, the capital of Formosa, gave the en- 
 
124 HEALTH AND EMPIRE 
 
 couraging result that equal numbers treated under 
 precisely identical conditions, on the one hand with 
 serum and on the other by general methods without 
 serum, showed a respective mortality of 34 and 
 62 per cent, in favour of the serum. On the other 
 hand, 200,000 persons had been treated in Formosa, 
 and in Osaka, the Manchester of Japan, with a 
 vaccine as a preventive, and very few of them con- 
 tracted the disease. 
 
 The Serum Institute in which these sera are pre- 
 pared is a different building to the original Institute 
 for Infectious Diseases, and is located in Shiba Park, 
 Tokyo. It was established in 1896 by the state, 
 also with Kitasato as its zealous president, with 
 various rooms and stables for the different depart- 
 ments of its work. Another stable is established in 
 the southern part of the city, three miles from the 
 Serum Institute, consisting of seven buildings for 
 the constant accommodation of 150 animals. A 
 special interest attaches to a separate building, a 
 veterinary isolation hospital, intended for quarantine 
 purposes in case of an infectious outbreak amongst 
 the animals, with stabling for 50 horses. The 
 bottling, labelling and other processes connected 
 with the work are done by little Japanese women, in 
 white antiseptic overalls, a strange illustration of 
 modern developments in Japan. 
 
 Finally, mention must be made of the Lymph 
 Institute, established by the state in 1896. A 
 similar institute built at the same time had a brief 
 career at Osaka. The first institution for the pre- 
 paration of calf lymph in Japan was founded by the 
 
"SEEK AND YE SHALL FIND" 125 
 
 government in 1874, but was closed in 1888, and the 
 production of lymph was left to several irresponsible 
 private institutions. The present building is the 
 result of a representation made by the Central 
 Hygienic Bureau to the Minister of Home Affairs, 
 under whose supervision it remains. The expense 
 of maintenance for 1903 was 46,000 yen (4600), in 
 return for which sufficient lymph was produced to 
 vaccinate 4,000,000 persons. The Lymph Institute 
 also is under the presidency of Kitasato. The 
 price of one tube of lymph, sufficient for five vac- 
 cinations, is five sen, or one penny. To those who 
 purchase it for charity half-price is charged, and this 
 accounts for over half of the 600,000 or 700,000 tubes 
 sold annually. 
 
 When we consider that in 1868 the Shogun was 
 still in power, and Japan was little in advance of 
 China in her knowledge of western civilisation, these 
 results are perfectly astonishing. If so much can be 
 done mainly, be it noted, by direct government 
 action in thirty-five years, is it not melancholy 
 and ludicrous, is it not a scandal, that such work 
 in wealthy Britain should be allowed to languish and 
 to eke out a precarious existence for lack of funds, 
 whereby we are unable to prevent preventible deaths 
 occurring daily and hourly throughout the length 
 and breadth of the empire ? 
 
CHAPTER VII 
 
 MALAYA AND THE SCIENCE OF TOWNING 
 
 TWENTY-FOUR hours round, up the coast from Singa- 
 pore, backwards along the route I had come from 
 Calcutta, past Malacca, the oldest European estab- 
 lishment east of Suez, brought us up to Port Swetten- 
 ham, where one lands for Kuala Lumpur, the capital 
 of the Federated Malay States. The Malay Peninsula 
 is a long arm stretching downwards in line from the 
 boundary between Burmah and Siam, consisting in 
 its southernmost end of the Federated Malay States 
 and the separate sultanate of Johore on the one hand ; 
 and of " The Colony," or the Straits Settlements, on 
 the other. 
 
 The colony consists of the island of Singapore 
 and a few scattered but important settlements which, 
 except for the little island of Labuan off North Borneo, 
 we pass on our way up the west coast of the peninsula 
 the old settlement of Malacca ; Bindings, a slice 
 carved out of Perak, including a good port, which 
 may eventually be of considerable importance ; 
 Province Wellesley on the coast above Perak, the 
 northernmost of the Federated States ; and the island 
 of Penang opposite with its well-known port. 
 
 The four Federated Malay States, on the other hand, 
 are Perak, in the north, running up to the level of 
 
 126 
 
MALAYA AND SCIENCE OF TOWNING 127 
 
 Penang and separated from Lower Siam by the 
 independent states of Trengganu, Kelantan and 
 Kedah, which have lately come under British pro- 
 tection ; Selangor, in the centre, containing the 
 capital, Kuala Lumpur, and Port Swettenham, where 
 I landed ; Pahang, along the east coast ; and the 
 Negri Sembilan, in the south, including Port Dickson, 
 from which I left on the return journey to Singapore. 
 The southern end of the peninsula, between these 
 states and the island of Singapore, constitutes the 
 quasi-independent sultanate of Johore. 
 
 But neither the Federated States nor Johore or 
 the protected states are independent of the kind 
 British lion, who supervises their foreign relations, 
 and has a considerable influence in the management 
 of their internal affairs. 
 
 The Federated States have not rightly earned their 
 title to the name, for they are not properly federated. 
 Perak is by far the richest ; and they only agree to 
 work together and subscribe for a few common 
 purposes, as for instance, the forests, the " Malay 
 Guides/' and their Resident - General, Sir W. T. 
 Taylor. Each separate state is governed by an 
 English Resident from the Straits Settlement Civil 
 Service cadets, as they are called. These officers 
 appear to take the " advice " of the governor of 
 Singapore, who is high commissioner of the Straits 
 Settlements, and undertake to enter into no relations 
 with foreign powers. 
 
 We have already referred in a previous chapter to 
 the recent history of these states as it affects the 
 native population. Their present position is of 
 
128 HEALTH AND EMPIRE 
 
 economic interest in that they are going rapidly 
 ahead on the strength of their tin mines and voluntary 
 Chinese labour. They supply 70 per cent, of the 
 world's tin, which in 1903 accounted for 72,500,000 
 out of their 78,500,000 dollars' worth of exports ; 
 and on this the public revenue largely depends. 
 In other words, they are dependent for most of 
 their wealth on Chinese labour. The conditions are 
 very similar in many ways to those of South Africa, 
 about which there was five years ago so much con- 
 troversy, but fortunately for the Malay States their 
 procedure was not known to the party politicians 
 at home. Here too was a virgin country, largely 
 covered with dense jungle, and inhabited by a race 
 who loved a simple life, and had no desire to assist 
 the mineral prospectors in their search for wealth. 
 Despite the ideals of certain sections of the com- 
 munity at home, the search for wealth continues, as 
 it will always continue, to be nature's incentive for 
 the development of new countries. The poet may 
 rave about the natural beauties of the jungle ; Mr. 
 Ruskin might deplore the gross vulgarity of the rail- 
 way ; and many of us, from St. Francis down to ex- 
 President Roosevelt, have extolled and shall continue 
 to worship simplicity in all its forms. But nothing 
 can blot out the fundamental principle of the struggle 
 for existence, and, as its correlative in modern life, 
 the struggle for luxury and wealth. This it is 
 although as moralists and artists we regret it that 
 constitutes the moving power for development of 
 natural resources in the world at large ; it is this 
 thirst for wealth which introduced Chinese labour 
 
into South Africa and into the Malay Peninsula, 
 and, in the latter case, has directly resulted in an 
 astonishing development of the natural resources 
 and powers of the country. 
 
 The term " natural development " is used ad- 
 visedly, as a convenient phrase to distinguish between 
 the exploitation of animate and inanimate wealth. 
 It is surely a mere convention ; for there can be 
 hardly any really greater approach to nature in 
 growing crops and other living produce than in 
 digging up the minerals found in the soil. Indeed, 
 the gold or the tin or the diamonds are the natural 
 product of the untrammelled forces of nature, while 
 rubber, coffee, wheat, fruit and flowers, if grown with 
 a view to their utility, are the result of the direction 
 and perversion of nature's forces by man. The final 
 preparation of the mineral and the final preparation 
 of the vegetable or animal growth is in each case 
 artificial, the product of the working of another of 
 nature's products, the ingenious mind of man. 
 
 But granted that, through the more rapid trans- 
 lation into interchangeable wealth that is, into gold 
 coin of work upon minerals granted, in other 
 words, the attraction of the latter to many who seek 
 wealth for its own sake and are inspired by no very 
 elegant ideals of life we shall probably all agree 
 that the convention which assigns to labour engaged 
 upon the living products of nature the epithet 
 " natural " is useful, if illogical ; and we will also 
 agree that the term carries with it a very different 
 distinction of charm, of art, and of ease, in favour 
 of the more easy-going pastoral pursuits. Probably 
 
130 HEALTH AND EMPIRE 
 
 I am in a very small minority in assigning the higher 
 reverence to those who, engaged in the pursuit of 
 mineral wealth in all its uncomely surroundings, 
 maintain a high standard of principle and integrity, 
 while making the most of the mineral assets of the 
 world. 
 
 Nevertheless, one must bow to the public view ; 
 and as some recommendation for the untiring in- 
 dustry and bold resource which have developed the 
 tin mines in the Malay States, I would submit the 
 fact that the same qualities were also in 1904 planting 
 rubber, coffee, tea and cocoa, right and left in places 
 where the jungle had been, unnaturally, cleared away 
 by the axe and by fire. Thanks to modern inven- 
 tions, largely the result of modern wealth derived 
 from the exploitation of the world's minerals, the 
 world calls aloud for rubber ; thanks to science, far 
 more than to the teetotalers, the world continues 
 to call aloud for tea, cocoa and coffee. If these 
 articles could be produced economically in the Malay 
 Peninsula, it was conceived that an industry would 
 have been found not only to give employment to the 
 Malays and employment, we are all told, is good for 
 moral development but also to provide a secure 
 basis for the finances of the country, in the event, 
 which must always be kept in view, of a possible 
 exhaustion of the mineral wealth. 
 
 Before the days of the rubber boom this seemed a 
 serious danger. Some of those in authority saw signs 
 of the alluvial tin giving out within ten years and 
 doubted if the underground mines and the gold and 
 other minerals would be able to maintain the revenue. 
 
MALAYA AND SCIENCE OF TOWNING 131 
 
 This however was no reason for delay in making 
 the most in the immediate future of the mineral 
 deposits already known. It was probable that, 
 during the course of active industry associated with 
 the life of the tin mines, other minerals would be 
 found, and petroleum was not one of the least 
 probabilities. Many people have urged the contrary 
 procedure in connection with the South African mines, 
 contending that it would be better to develop them 
 slowly, by the use of such native labour as is available 
 in the country, in order that the agricultural and 
 other developments of the country may march with 
 it side by side. 
 
 But the history of the world's progress points in the 
 opposite direction ; if I wait to shoot at goal until 
 the other forwards are up, the opening will be lost. 
 
 A suitable analogy is supplied by scientific re- 
 search. Had Darwin only worked along lines of 
 which he saw the end, had he chosen only those 
 particular investigations which seemed to him likely 
 to be of immediate utility to the world, he would 
 never have collected the vast array of facts which 
 eventually ended in the greatest and most useful 
 addition to knowledge that has been made in modern 
 times. The incentive of the research worker is 
 interest in the codification of nature ; the smallest 
 possible anomaly may interest him, and he pursues 
 it, not knowing in the least where the pursuit may lead 
 him. Here is developed a vast industry of know- 
 ledge, from any corner of which at any moment 
 results of the greatest practical value are constantly, 
 though purely by chance, being derived. The lesson 
 
132 HEALTH AND EMPIRE 
 
 surely to be learned is to make the most of what you 
 have, and either yourself or by others to be constantly 
 applying the test of utility to the result of your 
 labours. In the case of gold no such test is needed 
 gold is, on the face of it and immediately, useful to 
 the philanthropist and to the statesman, as well as 
 to the scoundrel. Go ahead, produce it as quickly 
 as you may, bring out your talent from the napkin, 
 use it and put it out to usury, and you will be re- 
 warded tenfold. 
 
 For the present, therefore, the Federated Malay 
 States are developing themselves on the hypothesis 
 that the tin mines will continue for some time yet to 
 be a source of wealth to the country, and that, when 
 they fail, other sources of revenue will have been 
 found to maintain their advance. It is undoubtedly 
 a risky process ; for the future of the country depends 
 partly on chance that is, on conditions little known 
 still more on the continued vigilance and industry 
 of its own officials, and the continued commercial 
 activity of the industrial community within its 
 borders, inspired, if you will, by greed and other 
 natural incentives. But nothing venture, nothing 
 have. England would have been mere England, or 
 less, had it not been for the ventures, for instance, 
 of the Elizabethan navigators and explorers. The 
 British, too, have always enjoyed their gamble in life. 
 
 The value of mineral development is well illus- 
 trated by the capital of Selangor and of the Federated 
 States. An hour and a half up the single line of 
 railway, hewn through dense jungle, which appears 
 uninhabited except for an occasional^clearance, com- 
 
MALAYA AND SCIENCE OF TOWNING 133 
 
 prising tin mines and a few surrounding huts, 
 bring one the thirty miles from Port Swettenham to 
 Kuala Lumpur, a city of 35,000 inhabitants, an 
 epitome of modern civilisation, wonderful all the 
 more by contrast with the preceding jungle. By 
 the census of 1901 the population was given as 
 follows : 
 
 Chinese ...... 23,181 
 
 Indians ...... 4,435 
 
 Malays . , : , Y . . 3,727 
 
 Europeans . . . . . 200 
 
 Others . i . . . . . T 838 
 
 Total . . t-'-' 1 * , 32,381 
 
 In 1891 the population was only 19,020 ; ten years 
 showed therefore an increase of 70 per cent. The 
 town is scattered at the foot of a cluster of small, 
 richty grassed and wooded hills, each one of which 
 is capped by a comfortable-looking bungalow or two. 
 The streets are broad and good, all radiating roughly 
 from the magnificent government building, one of the 
 best bits of modern architecture to be seen in the 
 east. It is a long stone edifice, with a central tower 
 in size and line recalling the Imperial Institute 
 with open spiral staircases running up two flanking 
 towers. In front of this imposing symbol of empire- 
 building a fine grassy cricket-ground, and a white- 
 flannelled cricket match in progress ; on various 
 sides of it the club and the hotel, the church, the 
 post-office, and a bandstand from which the band of 
 a Sikh regiment was playing selections from The 
 Country Girl. A town hall, municipal offices and 
 
134 HEALTH AND EMPIRE 
 
 other commercial and public buildings were in course 
 of erection ; a few out of the thirty motor cars 
 licensed in the city whirred along the road ; and a 
 motor omnibus plied over the neighbouring mountain 
 pass. Apart from motors and private traps, the 
 only vehicle was the ubiquitous rickshaw. The 
 traveller and his baggage were run up by Chinese 
 coolies in three rickshaws from the railway station 
 to the hotel, which, judging by the private hospitality 
 of the white man abroad, cannot carry on a very 
 thriving trade. 
 
 I suppose it would be impossible to stay with any- 
 body in Kuala Lumpur who did not illustrate by his 
 existence there the active development of the place. 
 My own most hospitable host emphasised the scien- 
 tific side of this development, Dr. Daniels having 
 exchanged his position as tutor at the London School 
 of Tropical Medicine to which he has now returned 
 for that of director of the Institute for Medical 
 Research at Kuala Lumpur. This institute was 
 originally intended for the investigation of beri-beri, 
 with the view to its prevention. The need for it is 
 fairly well shown in the fact that whereas by the 
 census of 1901 the population of the Federated 
 Malay States was 678,595, the number of deaths from 
 beri-beri in 1900 was 1466 ; and whereas the popula- 
 tion of the Straits Settlements was 572,249, the num- 
 ber of deaths from beri-beri in 1900 was 298 ; so that 
 1764 deaths occurred from beri-beri out of a total 
 population of 1,250,000. If in London 7000 people 
 died in a single year from one definite and preventible 
 disease, it would assuredly be necessary to adopt 
 
MALAYA AND SCIENCE OF TOWNING 135 
 
 special measures for its investigation and preven- 
 tion. 
 
 The Malay States therefore started this institute 
 under the care of Dr. Hamilton Wright, from McGill 
 College, Toronto. But the work of the institute has 
 rapidly extended in other directions. Exhaustive 
 monographs have appeared both on the subject of 
 beri-beri and on that of malaria ; other diseases are 
 constantly under investigation ; and a small research 
 nursery and a glass insectorium, kept at an uncom- 
 fortably high moist heat, afford opportunity for 
 research into the diseases of rubbers, sugar-cane, 
 coffee, grains and fruit-trees, by the forest depart- 
 ment ; while sheds and a paddock for cattle give 
 opportunity for the investigation, for instance, of 
 rinderpest. 
 
 But the most striking instance of development with 
 a view to the future lies in the laying out of the city 
 itself. This has been to a large extent due to the 
 work of the president of the sanitary board, an old 
 English public-school boy, who had spent a varied life 
 in America, in Australia, and in Rangoon, since he, 
 as sanitary engineer, twenty-five years earlier, laid 
 out the streets of Kuala Lumpur. At that time the 
 city was in its infancy, and it required consider- 
 able foresight and perseverance, in the face of very 
 natural opposition, to lay down the streets, 120 feet 
 broad, which are now one of the most attractive 
 and healthy features of the place. " Always look 
 fifty years ahead and if possible a hundred." The 
 president's motto for sanitary engineering, learned 
 in Australia, applies equally well to other things 
 
136 HEALTH AND EMPIRE 
 
 than drains and streets and to other lands than 
 Malay. 
 
 But this motto was not known to the government 
 of Selangor in the early days, and for want of it in 
 1904 they had recently had to pay 52,000 dollars for 
 two dirty old ramshackle houses that were in the 
 way of a new street, whereas in 1891 they would 
 only have had to pay 3000 dollars ; the whole of 
 this street would then have only cost 25,000 instead 
 of 150,000 dollars. 
 
 " The cost of improvements," said the president 
 of the sanitary board, " should largely be borne 
 by futurity." " That's all very well," said my host, 
 " when you are sure of your futurity, but if your 
 futurity and your tin mines give out in ten years 
 where will you and your heavy municipal debt be 
 then ? ' Here we are back at the original principle 
 on which the Federated States have definitely 
 decided to progress. They take this risk, and, on 
 the strength of probabilities, make their improve- 
 ments by mortgaging their future. This policy, 
 with all its risks if carried too far, has the two great 
 advantages that it advertises the energy of authori- 
 ties, who dare, and that it ensures continuity of 
 policy to maintain the value of property acquired 
 and of improvements carried out. The essential 
 qualities that it requires are those of imagination 
 and common-sense, grounded on a wide appreciation 
 of local resources in relation to those of the outside 
 world. 
 
 But all the world over the pioneers and officials 
 of sanitary reform find that they are to a large 
 
MALAYA AND SCIENCE OF TOWNING 137 
 
 extent crying in the wilderness. It is lamentable 
 to see, concurrent with the growth of towns, ay, 
 even in London in the present day, the growth of 
 insanitary conditions which it will be most expensive 
 to abolish, when they might have been foreseen 
 and entirely prevented from the outset. I was taken 
 round a quarter of the town to see some of the diffi- 
 culties. The sanitary board were struggling, for 
 instance, to keep clear a lane at the backs of houses 
 for removal of the nightsoil and for ventilation ; 
 they were opening up blind alleys ; and so far as 
 might be they were buying up land on a large 
 scale in advance and " bettering " it, so as to secure 
 at the same time a sanitary town and a good invest- 
 ment. They had embanked one side of the river ; 
 but the embankment had been carelessly done, so 
 as totally to prevent subsoil drainage from the 
 neighbouring shanties, which were accordingly sur- 
 rounded by puddles. The state engineer now pro- 
 posed to run a drain along the embankment ; but 
 for this there was no fall, and the true remedy would 
 be to remove the shanties, which were out of place 
 on a massive embankment close to government 
 buildings in a capital town. 
 
 The president of the sanitary board proposed a 
 bigger scheme, on town-planning principles, for a fine 
 carriage drive, with business and residential sites, 
 along embankments on both sides of the river the 
 ground at the back of the new sanitary board offices 
 to be bought at once, while fairly cheap, and the 
 sites of bad houses to be bought up and laid out for 
 buildings at a peppercorn rent, subject to the erec- 
 
138 HEALTH AND EMPIRE 
 
 tion of good houses within so many years, to revert 
 to government at the expiry of the lease. Here again 
 he would be building boldly on futurity. The cost 
 of the sites, the cost of the embankment, the cost 
 of roads, sewerage and general treatment would be 
 very large. During the period of the peppercorn 
 rental there would be no repayment ; but if the city 
 progressed along the lines of its recent very rapid 
 growth those sites would in fifty years' time be of 
 enormous value, and the investment would be amply 
 repaid. 
 
 This question of city development is one that is 
 constantly cropping up to all thoughtful observers 
 in local politics and administration, both at home 
 and in newer countries. Here in Kuala Lumpur was 
 a definite instance of the value of having laid out 
 certain streets on a proper scale from the first ; and 
 many complementary instances of economic loss 
 from failure to do so in course of development became 
 also apparent. In viewing the matter from that 
 outside point of view which is the essential privilege 
 of a traveller, there can be no doubt that the greatest 
 economy is effected in foreseeing the probable 
 development of a rural area into town, and in paving 
 the way for the change on a broad scale at a con- 
 siderable outlay. On the other hand, when a city 
 is already in existence, and the population of one 
 quarter shifts so as to turn it from a slum into a 
 thriving commercial or residential centre, economy 
 is again effected by taking time by the forelock and 
 spending money in anticipation of the change, 
 regardless of the inevitable outcry of the more timid 
 
MALAYA AND SCIENCE OF TOWNING 139 
 
 section of the community. " Always look fifty 
 years ahead and if possible a hundred." This policy 
 is well illustrated at home, as regards existing cities, 
 by the recent opening of Kingsway in London, and, 
 as regards the planning out of new cities, by the First 
 Garden City Limited at Letchworth. 
 
 To take the former instance first, it is a common- 
 place of political speeches to deplore the vast and 
 ever-growing municipal expenditure of the London 
 County Council and other great municipal bodies. 
 This is in no small degree due to the want of town- 
 planning in early days. In half-a-century London 
 has spent 20,000,000 on street improvements and 
 in the clearing of 104 acres of insanitary areas ; 
 down to 1908 nearly 50,000 persons had been dis- 
 placed at a net cost of nearly 3,500,000. The cost 
 works out at 32,600 per acre or 78 per person dis- 
 placed. In Leeds an area of 75 acres was cleared at 
 a cost of 500,000 sterling ; in Birmingham 93 acres 
 at a little over 500,000. 
 
 Take as a single instance the vacant site between 
 Aldwych and the Strand, on the north side of the 
 Church of St. Mary-le-Strand the central of the 
 three " island " sites resulting from the operations 
 for what is known as the " Strand Improvement." 
 This site has a superficial area of 2*98 acres, and for 
 this space the London County Council received more 
 than one offer of ground rent varying from 52,000 
 to 55,000 per annum, at length closing with the 
 French Syndicate at the higher figure. The grumblers 
 of course complained of the delay in accepting one 
 or other of these offers, while the valuable site was 
 
140 HEALTH AND EMPIRE 
 
 meanwhile left unproductive ; but the County 
 Council was looking well ahead, content with the 
 motto, " Better late than never," and the policy has 
 probably been a financial success, but only by com- 
 parison. 
 
 A similar carving out of the streets of Paris at 
 enormous cost was done by Hausmann under Napoleon 
 III. half-a-century ago, but here we see the faults as 
 well as the virtues of our French friends. Regard- 
 less of cost, the great boulevards were constructed 
 with a view far more to decorative effect than to 
 utility, and so to the cost of being late in their 
 mending was added the needless cost of extrava- 
 gance in space and disregard of commercial utility, so 
 that the burden on the ratepayers of Paris has been 
 greater in comparison than that ever laid on metro- 
 politan shoulders by the London County Council. 
 
 But, besides the cost of dissecting and renewing 
 a city already fully developed in any one quarter, 
 there is added the risk connected with the future 
 development of the municipality which has to bear 
 the cost. What if London should cease to grow ? 
 What if its growth should lead to a general system 
 of that return to the land which all in theory so much 
 desire ? It is conceivable, with improved communi- 
 cations by rail and motor, telegraph, telephone and 
 post, that factories themselves may migrate from 
 London to the country, and carry with them a pro- 
 portionate share of workmen and other dependents, 
 with their families, and the shops, public-houses, 
 lodging-houses and places of amusement that now 
 depend upon their custom. Should it once be shown 
 
MALAYA AND SCIENCE OF TOWNING 141 
 
 to be of economic value for factories thus to migrate, 
 the result would be a definite loss to the great towns 
 of ratepaying force, there would be fewer to bear the 
 burden of the improvements now being made, and 
 those that remained would be still more heavily 
 burdened to make up for the deficit. Our city 
 fathers are hampered by no such fear ; like the 
 government of the Federated Malay States, like 
 the president of the sanitary board in Kuala Lumpur, 
 they are building on the future. But it is well that 
 the public should realise it. 
 
 This question of the migration of factories to the 
 country is indeed of burning interest, for evidence is 
 constantly accumulating to show that such migration 
 is worth the manufacturers' while. Still more is it 
 shown to be economical for new factories to estab- 
 lish themselves from the first in the country, on sites 
 properly laid out for urban development. This 
 principle has become publicly known as the " Garden 
 City " movement, initiated, it is said, by Robert 
 Owen a century ago, but brought into the domain 
 of practical politics by a shilling book, " The Garden 
 Cities of To-morrow," written by Ebenezer Howard 
 in 1898. Owen proposed to found industrial villages 
 of about a thousand inhabitants on socialistic lines, 
 calculating that in twelve years the foundation 
 charges would be paid off and the residents estab- 
 lished as proprietors. 
 
 Howard proposed a Garden City of 30,000 in- 
 habitants on trust lines, calculated to develop the 
 whole estate in benefit for the community. The 
 essential principle of the scheme is to accommodate 
 
142 HEALTH AND EMPIRE 
 
 the growing demands of a residential population, 
 such as those which are adding dozens of streets 
 every year to the outskirts of London and other 
 great cities. Howard's idea is to induce industries, 
 either new or migrated from the cities, to establish 
 themselves on such model sites as Letchworth, and so 
 to form the nucleus of a moderate-sized city, in 
 which the workers shall live close to their work, 
 instead of spending two unhealthy hours every 
 day in the train, and shall work and play, and eat and 
 sleep, under the healthy conditions of an adapted 
 country life, with the added benefits of neighbouring 
 market gardens and facilities for interchange of 
 labour between field and town. 
 
 The promoters of the Garden City movement, 
 although for the most part professed philanthropists, 
 are intent, for the very purposes of ulterior philan- 
 thropy, on showing that their scheme is commercially 
 sound. The site of 3800 acres, now being actively 
 developed at Letchworth, has in a few years in- 
 creased its population of a few hundred to so many 
 thousand, and by the end of this year the company 
 intends to show a clean balance-sheet. If, as seems 
 probable, it is able to follow this up by paying its 
 retrospective and regular dividend of 5 per cent, 
 within the next ten years, the soundness of the prin- 
 ciple will have been proved. The next point, as 
 with the discovery of the Rontgen rays, will be the 
 interpretation and the results of that success. 
 
 In a way, the principle of the Garden City has been 
 already established at Port Sunlight, outside Liver- 
 pool, and at Bournville, near Birmingham. The 
 
MALAYA AND SCIENCE OF TOWNING 143 
 
 former, established by Messrs. Lever Brothers for 
 their workpeople, is engaged in the manufacture of 
 " Sunlight " soap. The founders admit that it has 
 been an expensive pleasure to them, for they have 
 not tried to make it self-supporting apart from the 
 factory, although they maintain that the sum of 
 10,000, representing interest on capital spent on the 
 buildings, is a legitimate charge on the business. 
 But Bournville, founded with no less philanthropic 
 intentions by Mr. George Cadbury, in order to manu- 
 facture his chocolate and house both his own workers 
 and workers in Birmingham under healthy con- 
 ditions, has definitely proved itself a profitable 
 investment, and as such has been generously handed 
 over by Mr. Cadbury to a public trust for the good 
 of the inhabitants. When Mr. Cadbury first started 
 work in the Birmingham factory, over thirty years 
 ago, 12 hands were employed. The business in- 
 creased until 300 were employed, and then, 
 further expansion being possible only at a pro- 
 hibitive cost, the business was moved four miles out 
 of Birmingham, and now employs 3400 hands. The 
 net income of the trust, apart entirely from that 
 of the business, is reckoned within forty years to be 
 20,000, and within a hundred years 160,000, while 
 on it, for six shillings a week, including rates and 
 taxes, a man can get a six-room cottage, and a 
 garden by which he is able regularly to save half-a- 
 crown a week. 
 
 The Hampstead, Ilford, Romford and Ruislip 
 garden suburbs round London, and similar recent 
 developments round many large towns in the United 
 
144 HEALTH AND EMPIRE 
 
 Kingdom, are illustrations of an intermediate effort 
 to house the people healthily ever further from their 
 business while still working in towns. 
 
 It is evident that we are dealing in the Garden City 
 movement with two problems housing, and, if it 
 may be so called, towning. It was the latter prin- 
 ciple which was so well illustrated in Kuala Lumpur ; 
 it is the former that is especially illustrated in garden 
 suburbs ; both are sought to be combined in the 
 Garden City at Letchworth. The same problems I 
 found in 1905 being solved on very similar lines by 
 the representatives of Krupp, the great firm of iron- 
 masters at Essen, in North- West Germany. 
 
 Four successive generations of the Krupp family 
 have been interested in the social welfare of their 
 workmen since the firm was founded in 1810, and 
 Essen, which practically consists of Krupp's depend- 
 ents, was in 1905 a town of 120,000 inhabitants. 
 But this development has not been allowed to take 
 place at random. Streets have been laid out accord- 
 ing to the formation of the ground ; houses have been 
 built to suit the varying needs of different grades of 
 the firm's dependents, and the result is four definite 
 and distinct " colonies," attached to the central 
 works, developed on the healthiest and most con- 
 venient lines possible. The saving thus effected in 
 the proper housing of their workmen by the em- 
 ployers themselves has very largely contributed to 
 the financial success of the firm. The late Friedrich 
 Krupp was one of the first philanthropists, as well 
 as one of the most successful business men, of the 
 German Empire, and he always insisted that, in 
 
MALAYA AND SCIENCE OF TOWNING 145 
 
 laying out considerable sums on the housing of his 
 workpeople, he was insuring his business over and 
 over again. 
 
 The proper laying out of a town is of course much 
 facilitated by despotic powers on the part of the 
 owners of the land. When Krupp made up his 
 mind to lay out Essen on certain lines, no one could 
 prevent him. So, when the Russian government 
 decided to lay out Dalny, the port forty miles from 
 Port Arthur, on a large scale, they too were able to 
 do it unimpeded. Dalny in 1904 was a surprising 
 instance of the ideal laying out of a city. A magni- 
 ficent harbour was already constructed when it was 
 taken by the Japanese in that year. Alongside this 
 harbour were ranged the warehouses, arsenal and 
 government buildings required for the purposes of the 
 port and administration ; but above the harbour a 
 large extent of land was laid out for the purposes of 
 the town and divided by roads radiating on the most 
 mathematical plan from the church at its centre into 
 sections to be allotted to different nationalities and 
 classes of the population. Many residential villas 
 had already been built on this plan on the side nearest 
 to the harbour, and were gladly appropriated by the 
 victors on their entry. It would be interesting to 
 know if Japan has followed out the remainder of this 
 scheme. 
 
 But the proper laying out of a town from its very 
 outset is not the unique privilege of a despot or a 
 despotic government. Adelaide, the capital of South 
 Australia, has strictly adhered to its original plan of 
 development in maintaining intact the park zone 
 
146 HEALTH AND EMPIRE 
 
 outside the original city and continuing its extension 
 on freshly laid out land beyond. In Canada again 
 that most surprising of all cities, Winnipeg, which in 
 the ten years before my visit in 1904 had doubled its 
 population, and in the next ten was expected, as the 
 great junction between East and West Canada, to 
 become the largest city in the Dominion, had to 
 some extent planned its development in advance. 
 There was abundant need for prompt action, as 
 tin shanties were being dumped down in every 
 direction, even in the busiest streets with fine front- 
 ages ; an illustration (Plate n) shows a potential 
 slum, and Mr. Henry Vivian in his recent visit to 
 Canada has found slums in the making all over the 
 Dominion. Canada has the good fortune to have in 
 Lord Grey a governor-general who has from the first 
 given active support to the Garden City movement 
 and is now engaged in preparing measures to meet 
 the evil. But the evil exists in every developing part 
 of the empire ; the pioneers of development are too 
 busy to pay attention to such ulterior considerations ; 
 and the mischief is being prepared, like a conjuror's 
 trick, while their attention is diverted. There is 
 even less reason for such neglect in an old-established 
 colony under stable administration, as for instance 
 in Hong-Kong, to which the next chapter is devoted. 
 In the most democratic of all countries, the United 
 States of America, whether you take San Francisco 
 in California, Chicago in Illinois, or Washington, the 
 capital of the Republic, the principle of the proper 
 laying out of a city is recognised as essential and 
 indispensable. The maps of San Francisco and 
 
^ 
 
MALAYA AND SCIENCE OF TOWNING 147 
 
 Chicago, divided into hundreds of rectangular blocks 
 of equal size, are proverbial, and the map of New 
 York, with its eleven " Avenues," intersected at 
 right angles by 160 odd " Streets," is far more 
 like a diagram than a map. But there can be no 
 doubt as to the health and the convenience of this 
 arrangement ; and straight lines lend themselves 
 almost as much to fine architectural treatment, if 
 the artists must be pleased, as the irregular and 
 crooked streets hated by the sanitarian as well as 
 by the business man, while as for magnificence no 
 one can dispute the pre-eminence of Washington, 
 the city of magnificent distances, laid out with broad 
 avenues radiating from the finely situated Capitol, 
 designed, be it said, by a French officer of Engineers 
 in the eighteenth century. 
 
 Chicago was rebuilt on its present lines after the 
 great and most beneficial fire of 1871, which did 
 40,000,000 worth of damage, and left 100,000 people 
 homeless. A similar most destructive fire in the city 
 of Baltimore, a few months before I visited it, had 
 already been turned to good account in the recon- 
 struction along new lines of the affected quarter. 
 
 We suffer now in London from the fact that the city 
 was rebuilt after the great fire in the seventeenth 
 century in neglect of Christopher Wren's plan and 
 without regard even to probable development. It 
 should be borne in mind that expense incurred 
 wisely in the housing and towning of a population 
 will not only promote the amenity, convenience, 
 rapidity of communication and conditions ensuring 
 the public health and prevention of disease, but will 
 
148 HEALTH AND EMPIRE 
 
 always be restrained by the instinctive business 
 wisdom of our people, which is often given far too 
 free play, and will in the end be a good business 
 investment. 
 
 The principles of the Garden City Association are 
 making headway. Sixteen estates covering 8380 
 acres have now been laid out on these lines, varying 
 in size from 53 acres at Harborne to 3818 at Letch- 
 worth. Birmingham in addition has scheduled 
 nearly 4000 acres in its town-planning schemes, 
 while the Ruislip Northwood scheme in Middlesex 
 covers 6000 acres. Other big schemes are being 
 undertaken in connection with the new Doncaster 
 district coalfield; the new naval station of Rosyth 
 with Dunfermline ; Barassie near Troon on the 
 Clyde ; Greenock ; Gourock and Edinburgh. 
 
 It is to be hoped then that in the future, how- 
 ever tardily, we may follow in the reconstruction of 
 our cities or quarters of cities, whenever we get the 
 chance, the examples of sound towning brought into 
 public notice at the recent town-planning conference 
 and exhibition ; still more that we may put a limit 
 to the inordinate growth of cities, which deprive man 
 of his individuality and make him a mere nut or 
 screw in the machine, by promoting the plantation 
 of industry in healthy surroundings and the growth 
 of garden cities and industrial villages rather than 
 of mere residential suburbs, with a view to " colonisa- 
 tion " of the country in keeping with modern de- 
 velopments. Do not let timidity be mistaken for 
 economic wisdom ; be bold ; " Always look fifty years 
 ahead and if possible a hundred." 
 
CHAPTER VIII 
 
 HOUSING AND THE FUTURE OF HONG-KONG 
 
 HONG-KONG is a concrete instance of the urgent need 
 for a housing scheme on a large scale, with a view to 
 futurity. It is indeed about as good an instance as 
 the most ardent sanitary reformer could desire. The 
 need for it is obvious ; the main lines of the required 
 reform can be imagined without difficulty ; a definite 
 scheme is easily conceivable, and the means by 
 which to attain it are within our grasp, so long as 
 Hong-Kong remains a Crown colony. 
 
 The need for it is obvious. It was the plague out- 
 break in Hong-Kong in 1894 that first brought the 
 unwelcome reminder to the western world that 
 bubonic plague did not become extinct in 1666. 
 Since 1894 plague has spread far and wide over the 
 globe, and claimed its 7,000,000 victims in India 
 alone ; but it has not yet lost its hold upon Hong- 
 Kong. In the year 1894, 2833 cases of plague were 
 reported ; 2550 died. The numbers of deaths in 
 successive years following were : 36, 1079, 19, 1175, 
 1434, 1022, 1562, 559, 1242 in 1903, and so on, with 
 a total of 11,093 up to the end of 1910. This in a 
 population, boats included, new territory excluded, of 
 under 350,000 is a very serious mortality, and for the 
 sake of the people themselves requires urgent attention. 
 149 
 
150 HEALTH AND EMPIRE 
 
 But the need for urgent measures is still greater 
 when we consider the commercial effect of plague in 
 Hong-Kong. Hong-Kong is the port of call, the 
 great centre, for all sea-borne traffic between Europe, 
 Africa and India, on the one hand, the far east and 
 America on the other. The volume of trade passing 
 through Hong-Kong is increasing yearly, and it will 
 probably increase at a still greater rate in 1915 when 
 the Panama Canal is opened as a rival to the Suez 
 route for traffic from Western Europe and the United 
 States to Asia. Epidemics follow trade routes the 
 history of the plague is a patent example of the fact 
 and plague at Hong-Kong is liable to be distributed 
 throughout the greater part of the world by direct 
 communication. 
 
 This danger is so real that the port of Hong-Kong 
 is declared infected, whenever plague is epidemic 
 there, and vessels thence subjected to protective 
 regulations, if not to actual quarantine, at Japanese, 
 French and other ports. During my stay for in- 
 stance at Hong-Kong a ship laden with passengers 
 and cargo returned from Saigon, having been turned 
 back at a clear loss to her owners of 1000. 
 
 The danger is all the more serious on account of 
 the close connection between Hong-Kong and South 
 China. Hong-Kong is the commercial depot of 
 South China ; practically all the trade between 
 Canton, the only port of importance in South China, 
 and the outer world, is carried on through Hong-Kong, 
 which has been suggestively called its suburb, eighty 
 miles off. Half-a-million of people pass each way be- 
 tween Canton and Hong-Kong annually, and some 
 
HOUSING AND FUTURE OF HONG-KONG 151 
 
 four thousand river steamers and eight thousand 
 junks annually enter the port of Hong-Kong from 
 the Canton and West River district. In 1894 the 
 plague infection was brought to Hong-Kong from the 
 mainland, where it had been raging in a number of 
 localities, although no opinion on the subject had been 
 forthcoming from the Chinese authorities. Since then 
 there is sufficient evidence to show that plague cannot 
 have been conveyed in any other way to Japan, 
 Australia or America, and it is almost certain that the 
 7,000,000 deaths in India were due to infection im- 
 ported by sea from Hong-Kong. 
 
 This instance of the ravages of plague may form 
 the basis of some observations as to the general need 
 for rehousing of the poorer parts of the population, 
 whom I may briefly call the poorer Chinese, in this 
 small but important colony. Hong-Kong has been 
 the kitchen which has sent out death and has 
 damaged commerce for sixteen years throughout the 
 civilised world, and the cooking-pot is the Chinese 
 quarter of the city of Victoria. It is hardly too much 
 to say that, if the grossly insanitary conditions of this 
 square mile or so of the earth's surface were to be 
 abolished, the greatest danger to the world of future 
 epidemics of plague would be entirely averted. 
 
 But to a visitor, and above all to a health- officer, 
 making a tour of the Chinese dwellings in Hong- 
 Kong, there was no need for an outbreak of plague 
 to emphasise the need for sanitary reform. The 
 acting medical officer of health for the colony took 
 me round some of the worst streets and into several 
 of the most typical dwellings. 
 
152 HEALTH AND EMPIRE 
 
 Hitherto the Chinese have built deep and high 
 houses on very narrow frontages, and each floor is 
 divided up into cubicles, most of which are devoid of 
 light. Here were " box-dwellers " with a vengeance. 
 
 One house, for instance, which we visited, in the 
 slums, gave us entrance up a very narrow staircase. 
 The first floor was divided into six cubicles by wooden 
 match-boarding partitions, only the front cubicle 
 being lighted from the front windows, while the rest 
 had only diffused light coming over the top of the 
 cubicle partitions from a side window in the passage 
 and from a window into the air-shaft at the back. 
 The rent for each cubicle was 4 dollars a month, 
 averaging 3 Jd. a night, or as much as a bed in London. 
 The lessee of this storey earned therefore 24 dollars 
 a month, as against the 15 dollars' rent he had to pay, 
 besides housing himself for nothing, and letting out 
 planks in the passage at one or two cents a night 
 to casual lodgers. The back of each house in this 
 street opened on to an air-well, so-called ; but the 
 air-well was nearly covered in by a roof, and en- 
 croached on by kitchens built out on each floor. In 
 most of the ten health districts into which the city 
 of Victoria is divided, the average number of 
 persons per floor was from 7 to 9 ; the average 
 number of persons per house was from 20 to 25 ; 
 and in half the districts the average number of 
 persons per acre, on areas built over, was over 450, 
 actually rising in one locality to 982. I cannot 
 ascertain any other city in the world which averages 
 for its whole area as many as 132 persons to the 
 acre, and yet this was the density of the population 
 
HOUSING AND FUTURE OF HONG-KONG 153 
 
 Of the city of Victoria, including all the outlying 
 vacant lands and villages, racecourses, cemeteries, 
 and public gardens. Glasgow, which is the most 
 densely crowded of the large cities of the United 
 Kingdom, is dissatisfied with its 61, London with 
 its 60 persons to the acre. Even the overcrowded 
 parish of St Matthew, Bethnal Green, twenty years 
 ago had only 168 to the acre. 
 
 Moreover these terrible conditions in Hong-Kong 
 are not growing appreciably better with the increase 
 of population. Between the censuses of 1896 and 
 1901 the average number of persons per acre had 
 increased from 117*4 to 129*3 ; the last annual 
 report, for 1909, shows an increase on the previous 
 year of persons per floor from 67 to 6*9, per dwelling 
 from 20 'i to 20*5, per acre built over from 247 to 255 ; 
 and there is no doubt that the increase will continue 
 unless arbitrarily stopped. This is a nice condition 
 for one of the chief centres of the world's commerce, 
 in frequent and close contact with China, the home 
 of all the plagues ! 
 
 The government of Hong-Kong have realised to 
 some extent the importance of the housing problem, 
 and passed in 1903 a new Public Health and Build- 
 ings Ordinance, which they have since amended in 
 a few minor points. By degrees the worst conditions 
 are being improved, and the new ordinance enforced. 
 At the time of my visit the medical officers of health 
 and their twenty-two inspectors were insisting on 
 cubicles being mere partitions, and not lath and 
 plaster walls ; these were to be clear of the floor, and 
 not to reach within 4 feet of the ceiling above; 
 
154 HEALTH AND EMPIRE 
 
 the minimum floor space was to be 64 square feet ; 
 only one occupant was allowed in each, unless it had 
 windows in front and rear, and then only two were 
 allowed ; windows had to measure one-tenth of the 
 floor area, one-half of the window being glazed and 
 one-half being made to open. On this point they 
 were at the time of my visit insisting universally on a 
 beginning being made every occupant was to have 
 50 square feet of floor space, and 550 cubic feet as a 
 minimum of air space, 1000 cubic feet being the 
 minimum for all but servants in the hill districts, 
 which are mostly occupied by Europeans. 
 
 But of course the houses still remained, just as 
 deep and dark behind and just as high, in streets still 
 as narrow as ever. For new buildings, indeed, the 
 plans of which would have to be passed by the 
 medical officer of health, the most complete details 
 seem to have been laid down. They were limited 
 to four storeys and 76 feet in height, and they must 
 not be more than half as high again as the street is 
 wide. Sanitary provisions were made against damp, 
 fire and rain ; the streets were not to be under 30 
 feet broad in the city ; back lanes, 6 feet wide, were 
 to be left for scavenging ; yards to be provided equal 
 to one-third of the area of the building ; and windows, 
 10 square feet and glazed, to be inserted fore and aft 
 on every floor. 
 
 Housing reform, however, is notoriously costly, 
 difficult and unsatisfactory, and on these old- 
 fashioned lines it supplies no real solution to the 
 problem of properly housing an increasing population 
 on a limited space. No houses were old enough to 
 
HOUSING AND FUTURE OF HONG-KONG 155 
 
 be condemned on score of age ; and to condemn one 
 for faulty construction would be to condemn all. 
 Window space and cubicle regulations, even pro- 
 visions for new houses are the mere mint and cumin 
 of the law. The weightier matters appear to be 
 omitted. 
 
 With such high buildings it would seem a mistake 
 not to insist on much more open space and on broad 
 streets at frequent intervals, for the sake of health, 
 even if unnecessary for the traffic, which consists only 
 of rickshaws and pedestrians. Land, as in London, 
 was extremely valuable, running up to 30 dollars 
 (545.) a square foot in the centre ; but the revenue 
 of the colony was in a very flourishing condition, 
 that for 1902 amounting to nearly 5,000,000 dollars, 
 an increase of nearly 700,000 dollars on the previous 
 year, while its debt was only 341,800 sterling, and 
 the financial position has improved considerably 
 since then. The government were proposing to 
 " resume " the most insanitary areas under a trust, 
 and this undoubtedly would be a good measure if it 
 were carried through vigorously and to completion 
 within the next few years ; but, in the absence of 
 any further room for building in the present city, 
 they were piling and filling in an area on the west 
 side of Quarry Bay, to be reclaimed from the sea on 
 the eastern outskirts of the city, with the view to 
 the housing there of more Chinese. Considering 
 the enormous expense involved this seemed a radical 
 mistake. 
 
 The real solution of the problem would seem un- 
 doubtedly to be a development on a large scale of 
 
156 HEALTH AND EMPIRE 
 
 the British territory on the opposite side of the 
 harbour. In India, for the prevention of plague on 
 a large scale, in dealing with the uneducated native 
 only one measure proved effective namely, total 
 evacuation of an infected village or quarter; and 
 that measure was almost invariably and completely 
 effective when it could be thoroughly carried out. 
 If therefore a permanent migration of the poorer 
 Chinese from Hong-Kong across the water to the 
 mainland on the other side of the harbour could be 
 effected, new quarters being constructed for them 
 and maintained under healthy conditions, there was 
 good reason to believe that plague would be for the 
 first time under control. 
 
 The harbour of Hong-Kong is an arm of the sea 
 dividing 300 square miles of British territory on 
 the mainland, including the peninsular and Chinese 
 city of Kowloon, from 30 square miles on the 
 island of Hong-Kong, which contains the city of 
 Victoria and comprises half the whole population 
 of the colony. This harbour is some 10 square miles 
 in area, varying in breadth down to ij miles at its 
 centre, so that communication from the city to the 
 mainland should not be very difficult. 
 
 When we came in from Saigon on 20th May 1904, 
 with the south-west monsoon, terribly hot and 
 sultry, behind us, the conditions were against en- 
 thusiasm ; but there was no doubt that the entrance 
 to the harbour was magnificent. We came in from 
 the west. On our right were the city and docks, fac- 
 ing the harbour, on the north side of the bulky little 
 island, 10 miles by 4, whose well-wooded sides sloped 
 
HOUSING AND FUTURE OF HONG-KONG 157 
 
 from the Peak, 1774 feet high, and other green- 
 covered mountains, most abruptly down to the water 
 all round the island. It was hardly conceivable that 
 there was a town as big as Newcastle-on-Tyne between 
 the foot of these mountains and the water. 
 
 But the mainland, to our left, was also British 
 territory, with a long row of reddish mountains, 
 sloping down more gently towards the seashore and 
 leaving a large tract of country between mountains 
 and harbour awaiting development . This country and 
 these mountains were in 1898 acquired by the British 
 government, in order to secure the safety of the 
 harbour from any attack from the mainland. The 
 limit of British territory is a line between Mirs Bay 
 on the east and Deep Bay on the west behind the 
 range of mountains ; and with heavy batteries at 
 either mouth of the harbour, Hong-Kong could 
 probably, even in the absence of the fleet, be de- 
 fended by land forces. The promontory of Kow- 
 loon, which until 1898 was all that we possessed on 
 the north side of the harbour, is perfectly flat, and 
 some 3 square miles in area. The population of this 
 new territory at the census of 1901 was 85,000, 
 apart from the 75,000 in Kowloon City, which is at 
 the base of the promontory and 4 miles by water 
 from Victoria, 
 
 A clumsy flat-bottomed " sampan " with sails and 
 oars took me off to the wharf, three rickshaws ran 
 me and my luggage along the row of great " go- 
 downs " or warehouses ; along a busy street of five- 
 or six-storeyed houses, their ground floors occupied 
 by shops with flaming vertical signboards, describing 
 
158 HEALTH AND EMPIRE 
 
 their business in bold picturesque Chinese characters ; 
 up the steep battery-path ; past the cheap-looking 
 stucco cathedral, to the station of the mountain 
 railway. From here a cable car, worked by an engine 
 at the top, took me in eight minutes 1200 feet up to 
 the Victoria Gap, in which is built the Peak Hotel, 
 looking Janus-like across the sea, both west and 
 north-east. The view as one rises is magnificent 
 the city spreading itself out down the side of the 
 mountain, with houses cut into its side, reservoirs 
 of brown or pea-green coloured water, and a few 
 tennis courts, with midgets playing about on 
 them, seen in miniature far below ; a sharp line of 
 wharves, broken only by the Blake Pier and Naval 
 Dock ; the harbour, studded with junks and sam- 
 pans and steamers, so close together that it was 
 hard to find a berth for our Telemachus, where she 
 could be safe against swinging her stern round 
 against that of the Poh-an on one side and the 
 Sishan on the other ; across the water the busy 
 promontory of Kowloon, fringed with warehouses, 
 dominated by barracks for a couple of Indian regi- 
 ments and buttoned up at its neck by the native 
 Kowloon City ; the whole scene backed by the distant 
 ruddy-brown mountains, glowing with the brilliant 
 golden-yellows of a sun sinking to its setting. Such 
 was the scene before which I had tea on the terrace, 
 and cooled in the delicious breeze sighing under the 
 Peak. Then, after sunset, empire turned into fairy- 
 land ; electric light shone up in a few bright spots 
 from the darkness of the city ; lesser lights distin- 
 guished the houses from the trees; every steamer, 
 
HOUSING AND FUTURE OF HONG-KONG 159 
 
 junk and sampan showed a quiet yellow fairy lamp 
 on the water ; and across the harbour the Kowloon 
 shore was lit up, fringed with a delicate chain of 
 pearls. 
 
 There, it seemed, was the solution of the problem. 
 Kowloon and the mainland must be developed into 
 a business and residential city for the Chinese, and 
 the slums of the island gradually abandoned. The 
 policy of the government should definitely aim at 
 the migration over water of the poorer Chinese. 
 To this end the vis a fronte must be combined with 
 the vis a tergo, attraction to the new quarter with 
 quiet but firm compulsion out of the old, the second 
 being only applied in inverse ratio to the success of 
 the first factor. If the policy of attraction be 
 successful, there will be no need to do more than 
 firmly and surely to apply the present regulations 
 under the new ordinance in vogue in the city of 
 Victoria. The counterpart of the policy of attraction 
 to Kowloon namely, the discouragement of resi- 
 dence in Hong-Kong is a subject that requires local 
 knowledge ; but it should not be difficult to find 
 some measures which would reduce the attractive- 
 ness of Hong-Kong for the coolie, such, for instance, 
 as raising the licences of houses of entertainment, 
 and enforcing the law more rigidly against restaur- 
 ants and shops in the poor quarter. Such measures 
 would greatly assist the success of Kowloon in the 
 struggle for the custom of the Chinese lodger. 
 
 If the new regulations as to streets and buildings 
 be properly enforced, there is no room available near 
 enough to their work for the accommodation of poor 
 
160 HEALTH AND EMPIRE 
 
 Chinese in the island. The gain of any sites that 
 may be furnished by costly reclamation must event- 
 ually be more than counterbalanced by the extra need 
 there will be of sites for European residences, go-downs 
 and offices, the new university, official buildings, 
 and shops. Even the new tramways will not induce 
 poor Chinese to live in any considerable numbers 
 on the unoccupied lands east of the city, if only on 
 account of the expense of transit ; nor is it desirable 
 that a Chinese city should grow up in that direction. 
 As the need for further Chinese labour grows, more 
 Chinese will be packed into the overcrowded quarters 
 of the city, and it will be more difficult than ever to 
 enforce proper sanitary regulations. 
 
 On the mainland, on the contrary, is a practically 
 limitless site, on which a large city, perhaps of 
 500,000 inhabitants, is likely to grow up within the 
 next fifty or sixty years. If this large population 
 be allowed to amass itself haphazard, very similar 
 conditions will grow up as are now responsible for 
 the continuance of plague in Hong-Kong, and com- 
 bative measures will be, as now, immensely costly, 
 immensely difficult, and, broadly speaking, quite 
 ineffective. The government should therefore focus 
 their attention, not on the slums of Hong-Kong, but 
 on the peninsula and the new territory on the main- 
 land. It is on the growth of the new city of Kow- 
 loon that the plague, on the one hand, and the pro- 
 sperity of the colony on the other, entirely depend. 
 Although it is objected that the Chinese are too con- 
 servative to leave the quarters in which they have 
 grown up, or have at least passed many years of their 
 
HOUSING AND FUTURE OF HONG-KONG 161 
 
 working lives, it would seem enough to realise that 
 the city of Victoria is the product of only half-a- 
 century's growth, and that the general experience of 
 treaty ports is that the poor Chinese will go where 
 they can live most cheaply. The whole success of the 
 policy depends therefore on healthy quarters being 
 provided for poor Chinese on the Kowloon side at 
 a smaller cost, transit included, than their present 
 quarters in Hong-Kong. If this be impossible, then 
 the cheapest present quarters must be stamped out 
 immediately, compulsorily and completely, at all 
 costs, so that the new accommodation should not 
 have the unfair competition of quarters that are 
 cheap only at the expense of the public safety. But 
 without any such compulsion it would be possible for 
 the government to devise a cheap and healthy lodg- 
 ing, with the advice of representative proprietors, 
 builders and tenants, as well as that of the health 
 officers and others of experience in the administra- 
 tion. 
 
 For this purpose, where the coolie would gladly 
 sleep in the open air, all that seemed needed was that 
 he should be screened from view and sheltered from 
 rain during the night. He required none of the other 
 purposes of a house. Even the model tenements, 
 already in 1904 occupied and said to be overcrowded in 
 Kowloon, provided such other luxuries as solidity, per- 
 manence, stuffiness and resistance to fire, for which 
 the tenant has to pay. Moreover, walls of Chinese 
 brick were apt to become absolute rat-warrens, 
 rendering disinfection useless. Rats were often found 
 back in a house within three or four days of thorough 
 
162 HEALTH AND EMPIRE 
 
 disinfection and fumigation. It should be con- 
 sidered whether it would not be advisable not only 
 to allow but to encourage the coolie to sleep in the 
 open air under proper restrictions. There is little 
 danger of plague infection amongst those sleeping 
 out of doors. 
 
 If the government made certain limited reserva- 
 tions of land in convenient spots, fenced in with 
 bamboo, appropriately floored and provided with 
 sheds, coolies would sleep there under the healthiest 
 possible conditions, whenever hard pressed for money, 
 instead of overcrowding the worst-managed houses 
 where they may be able to secure a night's lodging 
 on the stairway, or in the passages for a fraction of 
 a cent. This would add considerable strength to 
 the policy of attraction to Kowloon. It would be 
 worth while too to consider the advisability of 
 erecting houses in light reinforced concrete or in 
 the Japanese style of bamboo and paper, which are 
 very cheap, easily erected, and as easily burned 
 down and re-erected at very slight cost. Informa- 
 tion on this subject should be obtained from Japan 
 and, if found desirable, either the services should be 
 engaged of Japanese artisans and of some authority 
 on Japanese building, or else facilities should be given 
 to Japanese contractors to undertake the work. It 
 may be suggested that the experiment be made with- 
 out delay on a sufficient!}' large scale and under 
 sufficiently varied conditions to enable conclusions 
 to be drawn within one or two years on their re- 
 spective merits above all, in attracting the coolie. 
 
 It is said that such flimsy buildings would not 
 
HOUSING AND FUTURE OF HONG-KONG 163 
 
 stand the typhoons prevalent at certain periods of 
 the year in Hong-Kong ; but it would seem pos- 
 sible, if so, to devise some method of strengthening 
 the building sufficiently for the purpose, without 
 necessitating costly building in brick and mortar. 
 It is urged again in objection that the Chinese have 
 never been used to such buildings, and would not 
 make any use of them. There is no doubt that habit 
 and instinct are amongst the strongest factors, 
 amongst the greatest difficulties, which an adminis- 
 trator has to meet in adapting modern civilisation 
 to the use of a native population. But the strongest 
 instinct of all in the Chinese coolie would seem to be 
 the lust of economy ; and if his desire for gain has 
 not prevented his leaving his home, and in fifty years 
 making out of Hong-Kong a colony of 323,000 
 Chinese inhabitants, apart from the new territory, 
 it would seem equally possible that, with proper 
 encouragement from the government, he will not 
 refrain from sacrificing his instincts for a brick 
 building, if something far cheaper were provided. 
 
 In a small way this migration is already taking 
 place ; the census of 1906 showed 1800 fewer Chinese in 
 Victoria and 9000 more in "Old" Kowloon. One 
 would like to know whether sufficient steps have been 
 taken to secure proper housing conditions for these 
 new immigrants to Kowloon. If not, they constitute 
 an increasing danger to the colony and a new focus 
 for the germination of plague. 
 
 To give strength to this policy of attraction one 
 might suggest, after the example of Kuala Lumpur, 
 that the government, while retaining possession of 
 
164 HEALTH AND EMPIRE 
 
 the land, should grant leases to contractors and 
 builders at peppercorn rent for the first time of leas- 
 ing. It would then be possible for them to erect 
 cheap buildings, answering to all the requirements 
 of sanitation, and to sublet them on such terms as 
 successfully to compete with the unhealthy districts 
 in the city of Victoria. At the end of the first term 
 of lease, which must and need only be of short 
 duration say, ten years the lease might be put up 
 to auction and disposed of to the highest bidder, a 
 10 per cent, option being given to the holder for 
 renewal, improvements and buildings being included 
 in valuation. The government would then find 
 themselves in possession of a valuable property 
 giving an annual return, while still able to insist on 
 improvements or actual demolition and reconstruc- 
 tion of buildings before renewal of lease, should 
 experience or the growth of knowledge make it 
 desirable. Under no circumstances should the 
 government part with the freehold, which gives them 
 a most powerful lever for use in sanitary matters. 
 The arguments against land nationalisation at home 
 lose most of their force in a Crown colony. Special 
 terms would at first be given for the establishment 
 of such legitimate public attractions as joss-houses, 
 theatres, eating-places and shops. At the same 
 time a free and frequent service of ferries from 
 Kowloon to Victoria and back should be provided 
 in the early morning and late afternoon, at govern- 
 ment cost, to take the coolies to and from their work. 
 These ferries should run from the coolie quarter itself, 
 probably on the west of the peninsula towards 
 
HOUSING AND FUTURE OF HONG-KONG 165 
 
 Yaumati, to the centre of the wharves, so as to carry 
 the men practically from door to door. 
 
 I have never been able to see the objections to 
 public authorities providing free way over the water 
 in the same way that they provide roads at the 
 public cost over land. If a bridge is built across a 
 river it is done at the public expense, and toll-gates 
 are a thing of the past. If the scheme for a bridge, 
 which has been mooted at Hong-Kong, be impossible, 
 it surely would be equally to the advantage of the 
 government of the colony to supply a free ferry 
 across the water at probably lesser cost, including 
 running expenses, than it would take to build and 
 maintain a bridge. In fact, the London County 
 Council's free ferry between North and South 
 Woolwich supplies an instance in point. The chief 
 difficulty in inducing the Chinese coolie to live over 
 on the north side of the harbour of Hong-Kong, two 
 miles away from his work, would then disappear. 
 
 The reader will observe that the spirit of the 
 Garden City inspires these schemes at every turn. 
 Indeed it seems to me an essential duty of govern- 
 ments all the world over to make use of the advan- 
 tage given them by their knowledge and by their 
 power to take an active part in the development, 
 on a proper plan, of sites, in which the public interest 
 is particularly concerned, in the absence of that 
 great public benefactor, the speculative builder. 
 Considering the future of the port of Hong-Kong as 
 assured, it is necessary to its welfare that the new 
 city on the north side of the harbour be allowed to 
 grow up only according to a prearranged plan, so as 
 
166 HEALTH AND EMPIRE 
 
 to avoid the otherwise inevitable expense of broaden- 
 ing streets, buying up and demolishing houses for 
 the sake of public improvement, and the expense, 
 difficulty and unsatisfactory results of changing 
 the nature of whole districts as the call for increased 
 wharfage, railway sidings, factories or workmen's 
 accommodation becomes felt. 
 
 Upon the experience of most modern American 
 and Australian cities, and of the several other 
 instances quoted in a former chapter, an efficient and 
 representative committee should undertake within 
 six months to lay down complete plans, both final 
 and transitional, for the development of the new 
 city for a population of at least 500,000 persons. 
 On that basis streets should be marked out, and from 
 the first retained for that purpose ; the sites of 
 parks, chief public buildings and institutions de- 
 termined ; and the general situation and delimita- 
 tion decided of wharves and railways, of warehousing, 
 manufacturing and commercial quarters, of residen- 
 tial districts for poor Chinese, for seafaring and 
 artisan Europeans and for the wealthier population. 
 Terms of lease should be settled accordingly, the 
 strictest regard being had to the continual need for 
 expansion and to the paramount importance of 
 extended lines of communication by electric car, 
 rail and boat, both with the mainland and with the 
 island. Methods of communication should from the 
 first be established and run even at a loss comparable 
 with that involved in the making of roads in any 
 city or district in the world, from the days of the 
 Roman Empire up to the present time. 
 
HOUSING AND FUTURE OF HONG-KONG 167 
 
 The matter presses, for the government have now 
 to take into consideration the railway, 112 miles long, 
 from Canton to Kowloon, for which they had already 
 had the concession for four years before my visit, 
 and done nothing. 
 
 Construction was started in 1906; in 1910 the 
 British section of 23 miles was opened for traffic ; 
 and of the 89 miles in Chinese territory 35 miles 
 are now in operation. This railway should bring 
 by degrees all the export trade of South China to 
 Kowloon, the only competition being that of the 
 junk and steamer traffic down the 80 somewhat 
 perilous miles of the Canton River. Before this 
 railway is complete, plans for the development of 
 Kowloon should have been definitely determined 
 and initiated. These measures, it is hoped, would 
 destroy the " cooking-pot," and prevent either Hong- 
 Kong or Kowloon ever again being the centre for 
 the germination as well as for the dissemination of 
 plague to the whole world. 
 
 But Hong-Kong will always be liable to be in- 
 fected from China, where sanitary conditions are 
 not likely to be introduced within the lifetime of 
 present living men. For the security and welfare 
 of the port it is therefore also necessary to take 
 measures to prevent, so far as is possible, the intro- 
 duction of plague from China. The extent to which 
 this introduction takes place is astonishing. At 
 present the authorities profess an utter inability 
 to prevent the entrance of plague from the mainland. 
 Even if they examined every person on every boat 
 entering the harbour, the sampans, they declare, 
 
168 HEALTH AND EMPIRE 
 
 would get into the island, somewhere along the coast, 
 at night, if necessary. In 1900 no fewer than 412 
 dead bodies, all plague cases, were found in the 
 streets or floating in the harbour, the latter affording 
 an easy method of disposing of concealed cases, 
 especially for a large section of the population who 
 live on junks in the harbour over 46,000 in 1909. 
 The Chinaman hates dealing with his dead the corpse 
 is occupied by a devil, and it is best to keep out of his 
 way. It is therefore believed that a certain number 
 of moribund if not actually dead Chinese are dumped 
 upon the island. 
 
 Effective measures should in any case be taken 
 to prevent the introduction of imported disease. 
 This has been done with fair success in Japan, 
 despite the constant importation of disease from 
 Corea and China. Singapore is another instance of 
 a well-managed port into which plague has been 
 imported every year since 1896 without ever being 
 allowed to spread. A rough scheme may easily be 
 suggested. None but licensed craft should be allowed 
 to ply or stay in the harbour, none should be allowed 
 to touch at any other spot in the island without first 
 going into harbour, and none should be inhabited 
 at night except under special permit. The licensed 
 boats would be under constant supervision by the 
 port officer of health, who would thus be in a position 
 to control the arrival of any infected cases. The 
 reputed scandal of dead and dying bodies being 
 dumped down on the island from the mainland, if 
 substantiated, could be properly prevented by a 
 nocturnal police launch, with the co-operation at all 
 
HOUSING AND FUTURE OF HONG-KONG 169 
 
 points of the police on shore. To secure proper 
 policing of the harbour it should be closed from 
 sunset to sunrise by a steam launch patrol, enforced 
 if need be by a barbed wire boom at either end, with 
 police boat and shore police at other possible landing- 
 points. The relative position of the health officers 
 of the port and colony must be definitely determined, 
 so as to ensure their co-operation on a single course 
 of action. 
 
 Infection also from the secreted clothes of dead 
 people appears at present to be a possible factor of 
 importance in the spread of disease, and must be 
 prevented. 
 
 As to the building of coolie quarters at Kowloon, 
 it would be well so to arrange them as to make exit 
 possible only through one or two streets, giving con- 
 trol over residents, rats and goods escaping from the 
 quarter, in case it should be found desirable to burn 
 it down for suppression of plague. The isolation of 
 each block might be completed by running round 
 it a barbed-wire entanglement on the outside of an 
 open cemented channel on the ostensible pretext of 
 protection from burglary. Barbed wire might also 
 be introduced by regulation into the construction of 
 light buildings, so as to remove the fear of burglary, 
 which supplies a real reason, both in China and Japan, 
 for complete closure of houses at night. 
 
 It would be well to limit these houses to two floors. 
 The ground floor of every house should be raised, as 
 in the houses I saw being built in Rangoon, two feet 
 above ground-level, the intervening space being kept 
 open, as ensured by constant inspection by day and 
 
170 HEALTH AND EMPIRE 
 
 night and by the frequent use of the street hose for 
 cleansing this space. No house should be con- 
 structed without its plans having been sanctioned by 
 the sanitary authority as designed to fit in with 
 the system of surface drainage, which must be laid 
 down with a good flow, before building in any street 
 is begun. In Rangoon, much of which is built on 
 reclaimed land and is perfectly flat, the necessary 
 gradient is secured by the help of a pneumatic 
 system. No hollows capable of holding stagnant 
 water should be allowed to remain. 
 
 Overcrowding is the greatest possible evil in Hong- 
 Kong ; as many as eighteen individuals have already 
 been found in a single room of one of the new 
 " model " tenements at Kowloon. It could and 
 should be rigidly prevented by nocturnal police raids 
 and mufti inspections, with the imposition of penalties 
 severe enough to make it not worth the proprietor's 
 while, as in a recent case, to incur it for the thirtieth, 
 or even for a single time. In the lodging-houses in 
 the slums of the city of Victoria a number in large 
 Roman and in Chinese figures is painted up by the 
 entrance, to signify the number of lodgers for which 
 the house is licensed. There is then no further 
 excuse for overcrowding, if unexpected inspections 
 are properly carried out. But the magistrates in 
 Hong-Kong evidently do not realise the grave 
 importance of this question of overcrowding ; they 
 are loth to convict, and still more loth to impose an 
 effective penalty. It is evident that this must be 
 altered ; otherwise the law is brought into ridicule, 
 and housing reform is impossible. 
 
HOUSING AND FUTURE OF HONG-KONG 171 
 
 The clearing out of plague-infected areas must be 
 on a sufficiently large scale to be of any value, and 
 must be comprehensive and progressive in a definite 
 geographical order say, from east to west so as not 
 to admit of return cases in any area immediately 
 after clearance. This plan is facilitated by the 
 rectangular arrangement of the streets in Hong- 
 Kong. Accommodation must be provided for the 
 displaced population during burning and recon- 
 structing as for instance in the way proposed by the 
 medical officer of health for Bombay in mat sheds on 
 large permanent rafts. It must be recognised that 
 the ideal form of disinfection is the complete destruc- 
 tion of a quarter by fire, coupled with a barbed-wire 
 and trench barrier round the whole area to be burned, 
 so as to prevent the escape of rats and other living 
 carriers of infection, both large and small. The 
 great fire of London once for all stamped the plague 
 out of the city ; it is to the advantage of the com- 
 munity, not to its detriment, that conflagrations in 
 the poorer quarters should take place. All the usual 
 clauses, accordingly, with the view to making 
 buildings fireproof, should be cut out of the building 
 regulations. There should be no objection to this 
 policy on the part of the fire insurance companies, 
 so long as they are taken into consultation in sufficient 
 time to adapt their rates to the new risk of fire. 
 Every interest likely to be injured by the proposed 
 policy should be discovered, consulted and dealt 
 with on liberal terms, in order that the colony may 
 unite in a determined effort to stamp out the disease 
 on the above lines. 
 
172 HEALTH AND EMPIRE 
 
 The building of new houses one by one in old 
 quarters, as in old Kowloon City, with its 12,000 
 slum inhabitants, is as the filling of old bottles with 
 new wine. Kowloon City is a plague-spot threatening 
 the whole success of any scheme for the stamping 
 out of the disease, and it should be wiped out within 
 two years. A two-years' notice of intention to burn 
 down the city would avoid most of the expected 
 difficulty. If preferred, the burning might be done 
 piecemeal, with the use of barbed-wire fences on the 
 analogy of the driving tactics which brought the 
 South African war to a conclusion. 
 
 The expense of all such undertakings might well 
 be borne by a colonial loan, floated locally on govern- 
 ment security. There is no doubt the money could 
 be obtained at easy rates, without any recourse being 
 had to the London market, which might involve 
 financial loss from depreciation of silver and loss of 
 support from public opinion owing to lack of local 
 liability. Considering the immense interests at stake 
 and the exceptionally secure prospects of the colony, 
 a large outlay of money at first would be entirely 
 justified, so long as it were made comprehensively 
 and promptly, in conformity with a complete scheme 
 framed with regard both to the present and the 
 future outlook. The complete policy of the govern- 
 ment should be publicly explained, both officially 
 and unofficially, in order to win the confidence of all 
 thoughtful members of the community, and the co- 
 operation of the public, in vigorously assisting to 
 make Kowloon the only future residence of the poor 
 Chinese. Hong-Kong is and should remain one of 
 
HOUSING AND FUTURE OF HONG-KONG 178 
 
 the brightest stars in the British Crown, a guarantee 
 for the preservation in the Far East, so far as Great 
 Britain can secure it, of commercial efficiency, 
 tempered by justice, wisdom and humanity. 
 
 These suggestions were formulated on the journey 
 from Japan to San Francisco, in response to a semi- 
 official invitation to that effect, and were sent back 
 to the principal civil medical officer of Hong-Kong 
 for respectful submission to the new governor, Sir 
 Matthew Nathan, who was then succeeding Sir Henry 
 Blake in office. The colonial secretary, on the 
 governor's behalf, politely acknowledged the receipt 
 of the memorandum, and concluded his letter by 
 saying : " With your main idea, that the poorer 
 Chinese should be induced to leave Victoria and live 
 at Kowloon, His Excellency is in thorough accord." 
 
 The more technical criticism, which was especially 
 welcome, came from the principal civil medical 
 officer, whose position in Hong-Kong is recognised by 
 a seat on the Legislative Council of the colony, and 
 who had shown me much kindness during my visit. 
 " I am with you," he says, " as regards the advisa- 
 bility of regularly mapping out Kowloon now before 
 it is too late. I doubt though whether the Public 
 Works Department have sufficient staff to undertake 
 the work. 
 
 ' The question of resuming the infected areas in 
 Victoria is one of finance. The government have 
 already commenced this, and have this year resumed 
 Kan-u-fong, one of the most insanitary areas, and a 
 certain sum of money is to be provided in the esti- 
 mates every year for this purpose. Theoretically it 
 
174 HEALTH AND EMPIRE 
 
 would be better, were it possible, to do this, as it 
 were, altogether and as soon as possible, but it would 
 not be practicable; the resumption of Tipingshang 
 in 1895, a comparatively small area, cost the govern- 
 ment 1,000,000 dollars in compensation. 
 
 " Jap-built houses would never stand the rains we 
 have in the summer months. In forty-eight hours 
 we had eleven inches of rainfall last July, and the 
 typhoons would sweep them away. The Chinese 
 labourers are very averse to living away from their 
 work, and I fear could not be persuaded to live at 
 Kowloon. Many of them must do so, as the enforce- 
 ment of the overcrowding and cubical sections of the 
 new ordinance is driving them from Victoria. 
 
 " I think we must trust to a thorough cleansing of 
 the Chinese tenement houses in the winter months l 
 as our sheet anchor. This year we have only had 
 500 cases of plague in all, as against 1400 in 1903, and 
 the Chinese, as you know, for the first time, last winter 
 thoroughly co-operated with us in this cleansing. 
 
 " The prevention of imported cases is a very diffi- 
 cult one. We should require a land frontier guard, 
 as well as a harbour one. Then again there is the 
 south side of the island, which would have to be 
 watched." 
 
 Sir Patrick Manson, Medical Adviser to the Colonial 
 Office, and one of the greatest living authorities on 
 tropical medicine, was himself for several years in 
 practice at Hong-Kong. His own objections to the 
 
 1 Plague in Hong-Kong, curiously enough, is most prevalent in 
 the summer months, whereas in India it is in the summer months 
 that plague dies out. 
 
HOUSING AND FUTURE OF HONG-KONG 175 
 
 suggestions I have made were based on the same 
 grounds as those of Dr. Atkinson, that Japanese- 
 built houses could never take the place of brick for 
 the accommodation of the conservative Chinese 
 labourer, and that no scheme, mine or other, could 
 prevent the importation of cases into Hong-Kong 
 from Canton and Southern China. 
 
 These weighty opinions suggest that the only 
 difficulties in the way of my scheme are : firstly, the 
 construction of cheap houses, so as to withstand the 
 climatic conditions ; secondly, the prejudice of the 
 Chinese against anything new ; and thirdly, the 
 difficulties of administration. It would seem that 
 the details of construction could be met by the in- 
 genuity of Japanese or other enterprising builders, 
 whose advice might be enlisted ; the prejudice of 
 the Chinese, there can be little doubt, would be 
 entirely overcome by cheapness, if there were one 
 " cash " to be gained by the exchange ; and the ques- 
 tion of administration is one with which I believe an 
 active and vigorous administrator, if so determined, 
 would not be unable to cope. It is to be hoped that 
 Sir Frederick Lugard, at the end of his term of office, 
 may be able to boast of having exterminated the 
 plague, of having laid out the promontory of Kow- 
 loon and its surroundings on the most admirable 
 lines, and of having so secured the future health of the 
 working community in a British colony destined to be 
 one of the greatest centres of the world's commerce. 
 
CHAPTER IX 
 
 SCHOOLS AND PUBLIC HEALTH IN JAPAN 
 
 EVERY steamer arriving in Japan from Shanghai and 
 the south touches first at Nagasaki, the south- 
 westernmost port in Japan, on the open sea facing 
 China. We stopped there for a few hours, and after 
 being inspected at seven o'clock in the morning by a 
 couple of polite little Japanese doctors, some of us 
 put ashore in a launch, to satisfy our intense curio- 
 sity in this wonderful country. 
 
 Walking five miles across the neck of a promontory, 
 through typical Japanese rural scenery, we passed 
 on the way a little village school, and, hovering 
 about the windows, were warmly invited inside 
 by the headmaster. It was somewhat surprising 
 to find that such a village school, right out in 
 the country, was almost a replica of what may be 
 seen anywhere in England under the best condi- 
 tions done into Japanese. The building was in the 
 modern Japanese style, plain, spacious, clean, airy 
 and flimsy, being constructed of wood, and probably 
 very cold in the fairly severe winters which Japan, 
 like England, enjoys. Each room occupied the 
 whole breadth of the building, with large windows 
 on either side open to a considerable extent, giving 
 plenty of light and through- ventilation ; at one end 
 
 176 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 177 
 
 a blackboard and a few maps ; on the wall a few 
 diagrams, quite intelligible to the English eye, and 
 a few sentences in Japanese characters ; a dais ; a 
 table ; and a Japanese master or in one room a 
 mistress in native costume, with sandals on the feet 
 and a pointer in the hand ; down the room long rows 
 of double desks, occupied by little Japanese boys and 
 girls, with text-books in their own language but in 
 European form. 
 
 They were the same boys and girls as you may see 
 anywhere in England, only translated into the like- 
 ness of the Far East. We watched them at their work 
 for a few minutes ; to translate into English Tommy 
 Smith would rise to order, and sing out haltingly a 
 few lines from a book, while Johnny Binns and 
 Freddy Timms pinched each other, and Billy Jones 
 looked out of the window until forcibly reminded of 
 his master's presence. In this little village school 
 there were four hundred children in five classes, in as 
 many different rooms, drawn from all the country- 
 side, and it was easy to understand how the lower 
 classes of Japan in the present generation are growing 
 up at least equally well educated to our own, being 
 given by a proper system of state-provided education 
 every opportunity for development according to their 
 individual talents and positions. 
 
 The system of education is most complete. Ele- 
 mentary, secondary and higher education are all 
 under a single department of state, methodically 
 organised on a single rule for the whole country. 
 The only exceptions are Formosa, which has a 
 separate system under the governor-general of For- 
 
 M 
 
178 HEALTH AND EMPIRE 
 
 mosa ; the Nobles' and Peeresses' Schools, under the 
 department of the imperial household ; and certain 
 technical schools, under the departments of the 
 army and navy, agriculture and commerce, com- 
 munications and the interior. The minister of 
 state for education is responsible for and controls, 
 with the help of a considerable staff, all affairs con- 
 nected with education. Inspection is carried out by 
 five inspectors for the whole country, except For- 
 mosa, each having his appointed circuit. Under the 
 minister of state, a superior council of education 
 was organised in 1896, to discuss subjects submitted 
 to it, and to tender its advice on educational ques- 
 tions. This council includes certain e% officio mem- 
 bers and a considerable number of representatives 
 of the different faculties of the imperial universities 
 and of the different classes of " directors " or head- 
 masters. These are selected by the minister of 
 state from among candidates for the council, elected 
 and recommended by the bodies of officials they 
 represent two directors, for instance, of normal 
 schools, one director of public higher girls' schools, 
 four directors of private schools, and so on. There 
 is also a central board, under the minister of state 
 for education, which licenses teachers, after test- 
 ing their literary attainments, moral conduct and 
 physique. This therefore gives a large amount of 
 central control to the department of education. 
 
 For the purposes of local administration the whole 
 country, except Formosa, is divided into the " Hok- 
 kaido " (the northern island), and forty-six " f u " 
 and " ken " (prefectures or large counties). In each 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 179 
 
 of these divisions education is entirely under the 
 control of the governors, assisted by secretaries, 
 councillors, and a staff of inspectors and clerks. In 
 cities, towns and villages, all educational matters are 
 under the management of mayors or headmen, with 
 local councils under them and school committees 
 responsible for the attendance of scholars. 
 
 The population of 45,000,000 seems to be amply 
 provided for in its number of schools. There are 
 18,871 ordinary elementary schools, 1639 higher 
 elementary schools, and 256 middle schools ; 57 
 normal and 3 higher normal schools ; 630 supple- 
 mentary schools for technical instruction ; 229 
 industrial and apprentices' schools ; 50 special 
 schools ; 9 blind and deaf schools ; 8 government 
 teachers' training institutes ; and 2 imperial uni- 
 versities. The ten years following the Chino- 
 Japanese War in '94 showed art increase of 3000 
 elementary schools alone, in which nearly 2,000,000 
 more children were being educated, the present 
 number attending elementary schools being over 
 5,000,000. Before the Chino- Japanese War the 
 expenditure in the central department was 140,000, 
 it is now 500,000 ; the expenditure of the prefec- 
 tures was then 1,700,000, it is now 5,000,000. 
 
 In a country so alive to modern developments it is 
 not surprising to find most elaborate regulations for 
 the preservation of the children's health. In design- 
 ing a school, 36 square feet have to be allowed for 
 each child in the primary, and 54 in the higher 
 elementary schools. There are not many village 
 schools in the United Kingdom where so good a pro- 
 
180 HEALTH AND EMPIRE 
 
 vision is made. In the same way, the sizes of the 
 classrooms must be ample, 9 feet in height, and 9 
 square feet for each child. Strict regulations are 
 laid down for lighting, ventilation and heating. 
 Every room must have two entrances, and, if the 
 schoolhouse consists of more than one storey an 
 exception only allowed under special circumstances 
 it must have at least two staircases. The drains 
 are to be properly laid out a considerable advance 
 in Japan and good drinking water provided. The 
 height, width and length of desks, which are always 
 dual; the height, width and length of seats; the 
 height of the cross-pieces at the back, for both boys 
 and girls, are definitely laid down in five sizes. It 
 is, I fear, only a small proportion of education 
 authorities in England who as yet understand the 
 importance of proper provision in this respect, in 
 order to prevent injury to sight, bowing of the spine 
 and considerable detriment to education from un- 
 comfortable attitudes. 
 
 Ten years ago the importance of school hygiene 
 in Japan was not properly recognised ; it is now 
 fully realised and arranged for. Article I. of the 
 imperial ordinance relating to elementary schools 
 provides that special attention be paid to the physical 
 training of children. Military drill and gymnastics 
 on the German model are specially prescribed, as well 
 as suitable apparel to be worn, and appropriate 
 military songs to be sung at the same time. In 1897 
 another instruction was issued, prescribing, in detail, 
 routine and periodical cleaning of schools, and 
 cleaning after floods. 
 
In 1898, ten years ahead of the United Kingdom, 
 a departmental ordinance was issued instituting 
 school physicians in public schools, with definite 
 duties laid down. Every school, except those in 
 villages and towns of less than 5000 population, was 
 to have its school physician, appointed by the local 
 governor. Each of these officials was to visit his 
 school at least once every month, and at the begin- 
 ning of every term and the end of the school year, 
 in order to inspect the sanitary arrangements of the 
 school ventilation and lighting, desks and seats, 
 distance of front and back rows of desks from the 
 blackboard, distance between stove and nearest 
 child, temperature of classrooms, relation of school- 
 books and blackboards to the school hygiene, dis- 
 infection of schools, quality of drinking water, and 
 so on. In April and October he was to examine the 
 physique of all pupils, and prepare certificates of 
 the results for distribution to the parents. At the 
 outbreak of epidemic diseases in or about the school 
 he was to be responsible for closing the whole or part, 
 or preventing the attendance of certain children. 
 His duties as regards treatment of diseases in children 
 were confined to emergency measures in case of their 
 being taken ill at the time of his visits. On other 
 measures, which he might consider necessary for the 
 good health of the school or scholars, he was to 
 report to the director of the school and the local 
 governor might order him to carry them into opera- 
 tion. This ordinance was in 1904 being gradually 
 put into effect, and already a third of the schools 
 were thus provided with a school physician. The 
 
182 HEALTH AND EMPIRE 
 
 English system, in comparison, is more complete in 
 that every English village school is already assured 
 of medical inspection ; it is less complete in that it 
 provides for the inspection of every child only twice 
 or thrice in its nine years at school. It has the 
 advantage in that it enables the work of school 
 health to be carried out as an integral part of the 
 public health organisation ; the Japanese system, 
 however, provides for the school physicians to become 
 closely associated with the schools, whereas most 
 English schools have to content themselves with a 
 yearly visit from an unknown and frequently in- 
 experienced inspector. 
 
 The Japanese child goes to school when he is six 
 years old and stays till he is fourteen. It is inter- 
 esting to note that Japan, with her open mind, after 
 full investigation of modern systems of western 
 education, sides with Germany, Scotland, and most 
 other countries, in not thinking it advisable to 
 educate her children until they are six years old. 
 We in England, on the other hand, still retain the 
 custom of admitting children three years earlier, 
 and compelling their attendance one year earlier, 
 despite the general opinion of teachers that their 
 education is in no way hastened indeed, in the 
 opinion of many, it is retarded and despite the 
 general consent of medical men that infectious 
 disease of a most serious nature is often thereby 
 spread through the juvenile community, at an age 
 when the child is least able to hold its own. 
 
 In the curriculum of elementary schools, one of the 
 most noticeable points was the devotion of two 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 183 
 
 hours per week for instruction in morals and patriot- 
 ism ; another was the giving up of ten hours out of 
 thirty for girls, and twenty-eight for boys, to the 
 teaching of the Japanese language ; a third point 
 that attracted notice was the solo-singing for 
 singing is seldom heard by the visitor in Japan ; a 
 fourth lay in the three hours devoted to gymnastics. 
 In the normal schools, in which pupils were being 
 trained to become teachers, one of the chief ends laid 
 down for their training was the preservation of 
 health for health, it was remarked, is an essential 
 condition of activity. 
 
 Amongst other matters, the instruction given in 
 physiology and hygiene was classed under natural 
 history, and school hygiene was officially considered 
 a part of school management. I fear there are too 
 many indeed a majority of our English schools 
 where the question of school health, as a concrete 
 and definite subject of management, is never con- 
 sidered from year's end to year's end. It is to be 
 hoped that instead of doing mere lip-service to 
 regulations, as an irksome essential for the govern- 
 ment's annual grant, we may be learning, as Japan 
 has already learnt to good purpose, that the health of 
 the rising generation, especially during the period 
 of childhood, is one of the greatest assets in the 
 future strength of the nation ; that proper care for 
 their bodies at this age will enable them to grow up 
 useful and healthy citizens ; that proper instruction, 
 and above all the conscious cultivation of healthy 
 habits, may enable them to live healthily throughout 
 their lives ; and that, in matters of so great import- 
 
184 HEALTH AND EMPIRE 
 
 ance, education committees must give a fair hearing 
 to the advice of the profession which makes such 
 matters its special study. 
 
 The special care bestowed by Japan on her human 
 assets, in body and mind, is strikingly shown in the 
 Japanese prisons. Our distinguished medical mili- 
 tary attach^ kindly took me one day, while he was 
 awaiting orders to go to the front, to visit the Ichi- 
 gaya prison, on the outskirts of Tokyo. This is a 
 large institution, containing in its ample grounds 
 many slender buildings, in the usual Japanese style, 
 for 1300 male prisoners, undergoing sentences of 
 from two weeks to ten years. From a warder who 
 spoke a few sentences of English, we found certain 
 resemblances to the Borstal system in operation. 
 The different classes of prisoners were separated 
 except for work, but work is the keynote of prison 
 routine. Every prisoner is set down to do the work 
 for which he is most fitted ; and while on the one 
 hand the spell of prison life thus inculcates the 
 routine of useful living that may and should be 
 pursued on leaving the prison, on the other hand 
 13,000 of the 80,000 which the prison costs a 
 year are recovered by the work done. The prison 
 is a workshop, not a " house of correction " on 
 the melancholy lines on which we interpret the 
 term ; and the results are of the happiest 
 nature. 
 
 In one long, airy, well-lit wooden building, ten- 
 score decent-looking, busy men, in brown kimonos, 
 were sitting in rows down the floor, making grass 
 sandals, and it looked as if they did it with a will 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 185 
 
 and of habit, not simply on the entrance of our 
 official group, so that presumably they were paid 
 according to the amount of work they did. In 
 another room they were making thread ; in a third, 
 matting ; a couple of men were engaged in carving 
 designs in wood of considerable merit ; a roomful of 
 boys were making umbrella handles ; while a few 
 were cooking, and some were doing coolie work in 
 light chains, like those depicted in certain posters 
 about Chinese slavery in England. The men and 
 boys all work for ten and a half hours net every day, 
 four of which, in the case of boys, were educational. 
 The women in the prison twenty-one miles out mostly 
 do needlework. The system is surely excellent, and 
 it is hardly credible that a work of such public neces- 
 sity should be neglected in this country for fear of 
 competing with the manufacturers. If this is, as I 
 believe it to be, the ultimate reason for not adopting 
 the system widely at home, here, surely, is protection 
 run wild. 
 
 It is interesting to note that this system of im- 
 prisonment, in which a casual observer might be 
 led to see the superiority of Japanese administrative 
 ability over British, differs only in detail from that 
 adopted very generally throughout India, where for- 
 tunately the interests of the manufacturer do not, 
 or are not allowed to, compete with works of public 
 utility. I may add that the Indian gaol is managed 
 in all its departments by that maid-of-all-work, 
 the Indian Medical Officer. In large centres officers 
 are detailed as, for instance, at Lahore purely and 
 solely for the superintendence and general manage- 
 
186 HEALTH AND EMPIRE 
 
 ment of the gaol; in others as, for instance, at 
 Amritsar it is one of the innumerable duties of the 
 Civil Surgeon. The officer in charge of the gaol at 
 Lahore had, of course, the care of the prisoners' 
 health, but this was the least of his duties. It 
 might be thought that the discipline and general 
 management of an institution accommodating over 
 1000 prisoners would be a sufficient task for one 
 man, but, in addition, he had to arrange for them 
 to carry out work of various kinds, to purchase the 
 raw material, to enlist warders to supervise the 
 manufactures, to find markets for the goods, and 
 to arrange carefully the whole accounts of the 
 business. The carpets produced in the Indian 
 prisons are known to be amongst the best in the 
 world manufactured at the present day ; and in the 
 Amritsar gaol all the prisoners' clothes, blankets and 
 mats were made on the premises. One may well 
 have a regard for the rightful interests of manu- 
 facturers, on whom the whole wealth and stability 
 of the British Empire primarily depend ; but without 
 injury to them it is now becoming recognised as 
 both possible and advisable to develop those systems 
 by which our prisoners in the United Kingdom may 
 be encouraged and helped on towards a better and 
 more useful life than that which has landed them in 
 gaol. It is a complement indeed to the system of 
 national education. However well the young 
 generation might be educated, however well they 
 may in future be trained in morals and patriotism, 
 a certain proportion will always slide back in after 
 years into crime or misdemeanour. As by education 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 187 
 
 we try to give them a good start in life, so, by an 
 intelligent use of our prisons, we should give them a 
 practical incentive to return to that way of life 
 which is as much to their own happiness as it is to 
 the good of the community. 
 
 To turn now to public health, of the acute 
 infectious diseases Japan in 1908 suffered most 
 from enteric fever, which caused nearly 6000 
 deaths in 26,000 cases. Dysentery, most prevalent 
 from July to September, gave rise to nearly 25,000 
 notified cases and 6000 deaths ; and smallpox also 
 caused nearly 6000 deaths out of 18,000 cases. The 
 fourth most serious infectious disease was diphtheria, 
 mostly between November and February, also giving 
 rise to nearly 18,000 cases, of which nearly 5000 were 
 fatal. Cholera caused roughly 650 cases and 400 
 deaths; scarlet fever, 900 cases and 130 deaths a 
 very high mortality of 15 per cent. plague, 350 cases 
 with 280 deaths; typhus, 3 cases with I death. 
 Leprosy caused 8000 deaths and malaria nearly 800. 
 
 With regard to mental diseases, nearly 5000 
 persons were in confinement at the end of the year, 
 apart from 100 in temporary confinement and nearly 
 22,000 insane persons registered but not confined 
 in hospital. Of those confined in hospital 41 per 
 cent, recovered, 27 per cent, died ; while of the others 
 1 6 per cent, recovered, 15 per cent. died. 
 
 Of venereal disease there were over 74,000 cases, 
 47,000 prostitutes being submitted to inspection 
 every week, about 3 per cent, being found infected. 
 There were 564 "brothel-quarters" and 309 hos- 
 pitals for these women. 
 
188 HEALTH AND EMPIRE 
 
 Of all the causes of death tubercle is by far the 
 most frequent, showing the terrible hold that disease 
 has on Japan, owing probably in no small degree 
 to housing conditions. Of under 1,000,000 deaths, 
 over 75,000 occurred from tubercle of the lung, 
 14,000 of the intestine, 5000 of the brain, and it is 
 noticeable that over 63,000 others died from men- 
 ingitis. 
 
 The work of midwives is under control ; 1166 
 were newly registered in 1908, 1155 having passed 
 the required examination ; while a further 282 were 
 licensed to practise within a limited district. Of 
 the 26,000 registered, 7000 had passed the examina- 
 tion, 10 names were removed, and 600 died during 
 the year. 
 
 As to sanitation, the Japanese are taking up each 
 problem in turn, one at a time. Water-supply, the 
 most important in Japan, was already by the end of 
 1908 settled on a large scale for seven of the chief 
 and two or three of the smaller cities and was sanc- 
 tioned for thirty localities in all. An interesting 
 table in the annual report for 1907-1908 of the central 
 sanitary bureau, department of home affairs, gives 
 the proportion of population in each town and in each 
 prefecture served by various sources of water-supply. 
 In Tokyo 60 per cent, of the 2,170,000 inhabitants 
 are supplied from improved waterworks, 35 per cent, 
 from ordinary wells, 5 per cent, from artesian wells. 
 In Osaka, with a population of 1,218,000, 96 per cent, 
 are supplied from improved waterworks. The 
 whole country has a population of 49,000,000 ; 3 per 
 cent, only were supplied by improved waterworks, 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 189 
 
 5 by artesian wells, 68 by ordinary wells, 12 by river, 
 ii by springs, and the rest by ponds, rain water or 
 old-style aqueducts. The need of improvements in 
 the water-supply is shown by the occurrence of some 
 25,000 cases of typhoid fever in the year, with over 
 5000 deaths. 
 
 Water-supply is costly but remunerative ; sewer- 
 age is costly but unremunerative. It is not surpris- 
 ing to find sewerage schemes during 1907-1908 only 
 sanctioned for the four towns of Kobe, Hiroshima, 
 Nagoya and Sendai ; and the number of water- 
 closets only amounting to 3000. Scavenging is 
 more systematically done, some 3000 scavengers 
 being employed. 
 
 Slaughter-houses numbered nearly 1000, 52 being 
 public and the rest private. Twenty-one prefectures, 
 including Tokyo and Kyoto, out of the 27 had no 
 public slaughter-house ; but there were 8 inspectors 
 with 521 assistants engaged in this department alone. 
 
 Milk is drunk to the extent of 8,000,000 gallons 
 in the year, giving an average of ij pints a head ; 
 and in 1908 there were nearly 5000 dairies under 
 supervision. Samples were taken and tested and 
 fines inflicted not infrequently with regard to various 
 other articles of food and drink, 15 per cent, of 
 those of ice and snow and over 20 per cent, of 
 refreshing drinks being contaminated. 
 
 Vaccination, owing to the prevalence of smallpox, 
 is welcomed by the people, the number recorded 
 during the year of 1908 being 9,398,135 or over 18 per 
 cent, of the population, about one-fifth of these being 
 primary vaccinations. 
 
190 HEALTH AND EMPIRE 
 
 Latterly in Tokyo they have been demolishing 
 insanitary areas and widening streets, and soon they 
 will turn their hands to sewerage. Indeed, they 
 would probably have already undertaken this large 
 problem, had it not been for the heavy financial 
 demands of the Russo-Japanese War, which required 
 all their attention. This sewerage is badly needed, 
 for the sake of all the stagnant pools and irregular 
 ditches, in which the mosquito breeds furiously. 
 Fortunately this mosquito is mostly the culex, not 
 the anopheles. The culex annoys but it does not 
 carry the malarial parasite, and so in Japan they 
 have little malaria. 
 
 Indeed in Japan, where agriculture is a fine art, 
 where every scrap of useful refuse is economically 
 preserved on the Chinese plan and distributed over 
 the fields, house drainage is not so important as at 
 home. Her system of sewage disposal, like most 
 of her customs, Japan has derived from China, or 
 from a common source. In China it is recognised, 
 as has recently been worked out in England, that 
 for agricultural purposes every adult individual is 
 worth 175. 6d. a year, and sanitary visits are re- 
 quested from the passers-by at every turn of a 
 frequented road. The contractor for removal of 
 filth from the municipality of Shanghai actually 
 pays 8000 a year for the privilege. In our walk 
 across the peninsula from Nagasaki, we, with our 
 European noses, could not fail to be aware of the 
 Japanese system of sewage disposal, even if we had 
 failed to understand the meaning of the coolies pass- 
 ing along the road from the town, with covered 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 191 
 
 wooden buckets, hanging from either end of a pole, 
 over their shoulders. As a result, the ricefields, 
 in which the peasant works above his ankles in mud 
 all day, are really elaborate sewage farms on a large 
 scale, and managed by instinct on the most scientific 
 principles. There is no evidence that, in a suffi- 
 ciently moist country, any damage is done to the 
 public health by this system (Plate 12). 
 
 But it is strange to find that a people so delicately 
 refined throughout all classes in their appreciation of 
 form and colour and design should be so indifferent 
 to scent. This indifference is shown in the small 
 attention paid to scent in the flowers they cultivate 
 so ardently. It would be of interest to know whether 
 it comes from habit or from birth. We in England 
 should be inclined to say that their lack of smell is 
 as dangerous as sitting on the safety valve of a steam 
 boiler, for we associate the practical use of our nose 
 with leaking drains, and leaking drains with disease. 
 Perhaps we are wrong, or at anyrate should be 
 wrong if it were not for our water-carriage system 
 of sewage disposal. In Japan at anyrate no one 
 seems to mind the common smell of fresh 
 sewage. 
 
 This revives the question whether the late Vivian 
 Poore's system of rural sanitation can be used with- 
 out danger to the community for small towns, as 
 he showed it could safely be used in his own garden, 
 when properly superintended by himself. If pre- 
 served for three weeks, it is found that pathogenic 
 germs disappear, and it is therefore only a question 
 of difficulties of distribution and disadvantages of 
 
192 HEALTH AND EMPIRE 
 
 smell. Air-tight bins for removal would be a certain 
 improvement on the Japanese wooden tubs, and their 
 open earthenware receptacles fixed into the ground 
 below closet seats, from which the coolie has to rake 
 out the nightsoil with much fouling of the sur- 
 roundings, have nothing to recommend them. 
 These are difficulties that could be remedied ; the 
 smell could never be. 
 
 But it is one thing to devise an ideal system, 
 another to carry it out throughout a large com- 
 munity ; and experience in many English villages 
 shows it to be certain that, in any large community 
 comprising the less educated classes of our nation, 
 many householders would be entirely indifferent to 
 details of the system which are inseparable from 
 the public safety. The sewage would in many 
 cases be allowed to accumulate in heaps, causing 
 a standing nuisance and a great danger of pollution 
 by flies and dust if not, as for instance on a 
 chalky soil, of pollution of the water - supply. 
 Public scavenging and official supervision of night- 
 soil distribution are the answer, but it is doubtful if 
 the Britisher would ever allow the entrance to his 
 castle and the interference with his household affairs 
 which such public supervision, to be thorough, would 
 necessarily entail. 
 
 In Japan, however, the present system works 
 well throughout the country. Even in the large 
 towns it does not result in more than a nuisance ; 
 the sewerage of Tokyo therefore is not of the first 
 importance, and everything in this direction was in 
 1904, and probably is still, at a standstill for lack of 
 
SCHOOLS & PUBLIC HEALTH IN JAPAN 193 
 
 funds. It will be interesting as well as instructive 
 to learn the results of their scientific experience and 
 careful observation on the vital statistics of Tokyo 
 and other chief towns in ten years' time. If they are 
 able to show us that large aggregations of mankind 
 can safely dispense with the water-carriage system 
 which entails for us so much expense and trouble, 
 we who have at heart the reform of the public health 
 without undue cost to the community shall be among 
 the first to welcome their new experience. But the 
 chances are infinite to the contrary ; water-carriage 
 in a compact, busy community is by far the best 
 system all round. 
 
 This brief outline of sanitary and educational 
 administration shows the astonishing power of Japan 
 to study foreign systems and to apply them, as they 
 may require and as conditions may serve, to her own 
 use. The progress made in these matters in the last 
 twenty years suggests the progress the Japanese 
 nation is likely to make at least in every material 
 department of the national life, under the stress of 
 international competition, under the stimulus of her 
 remarkable energies and national spirit, during the 
 century now under weigh. 
 
CHAPTER X 
 
 THE EVACUATION OF NIU-CHWANG 
 
 {Reprinted by kind permission from " The Times"} 
 
 IT was a glorious summer afternoon as we sat 
 looking eastward from the first-floor verandah of the 
 Australian stationmaster's house at Yin-kau in North 
 China, across the broad river to Niu-chwang in Man- 
 churia, in the first few months of the Russo-Japanese 
 War, on Friday, 22nd July 1904. 
 
 On our left between us and the River Liao ran the 
 trunk line of the Imperial Chinese Railway, which 
 had just brought me up in thirty-one hours from Tien- 
 tsin, the military menagerie of the eight nations and 
 China, all Russians and Japanese included still 
 flying their respective flags and saluting each other's 
 officers in a friendly way in the streets ; up through 
 Shan-hai-kwan, where the 8oth Punjab Infantry 
 maintained the traditions of British soldiers for 
 hospitality, and where Sikhs were seen flag-wagging 
 on the Great Wall of China as the train steamed 
 through a breach in its fifteen feet of rough masonry. 
 In front of us was the terminus station of Yin-kau, 
 a small settlement, mostly of railway employees, on 
 the right bank of the Liao River ; on the station 
 platform were a score of Chinese troops, uniformed 
 in dark blue rags and old straw hats, armed with 
 Schneiders, Lee-Metfords and what not, filing off 
 
 194 
 
THE EVACUATION OF NIU-CHWANG 195 
 
 after their parade to receive the evening train. 
 Beyond the station and over the river, fifteen miles 
 to the east, lay the blue-grey hills, veiled in mist, in 
 which lay the junction of Ta-shih-chiao, where the 
 main Siberian line to Port Arthur was joined by the 
 branch Russian line from Russia-town, Niu-chwang. 
 Russia-town, with its solid railway station and 
 hotel and two or three dozen small houses, water 
 distillery, stores and coalsheds of galvanised iron, 
 lay three miles to the north-east, half left from where 
 we sat, on the farther bank of the Liao, which wound 
 down a devious course of twelve miles from the ridge 
 to our left, to its mouth, past our right, and out into 
 the sea to the right behind us. Away in the distance 
 on the other side, twenty miles to the south-east, we 
 could just make out the great hill of Kaiphing or 
 Kai-chan, now for some days past in Japanese hands. 
 The river close to our right was studded with junks 
 and sampans, paddling upstream with their strong 
 oars or running down with the tide. The Russian 
 official launch, which had kindly put across to take 
 a Chinese railwayman, injured by a falling sleeper, 
 over to the hospital, was busily threading its way 
 upstream. On the other side was the fort, and up 
 the farther bank there spread in the endless distance, 
 fringed along the water's edge by a forest of junk 
 masts, the dusty tops of modern Niu-chwang. 
 
 On our side was the blind end of the Chinese 
 railway, neutral ground and peace ; on the other the 
 Russian railway terminus, Russian usurpation and 
 war. For many days past the sound of distant firing 
 had been heard south of Ta-shih-chiao, and Chinese 
 
196 HEALTH AND EMPIRE 
 
 had reported fighting, in quality and result as 
 vigorous as imagination could conceive. No Russian 
 sick or wounded had at any time been brought into 
 the town ; no one knew the strength of the garrison, 
 and, apart from the soldiers on guard and at work 
 about the town, it was only known that a few days 
 previously 1500 men had marched in again after the 
 short absence of an equal number in the neighbour- 
 hood. Reports of evacuation had all been false, 
 the frequent movement of troops out and back being 
 due either to a desire to impress the Chinese with 
 a false idea of Russian strength, the exit generally 
 taking place by night and the return by day, or else 
 to a systematic method of maintaining efficiency in 
 the garrison. No foreign battleships were in the 
 harbour. Only the Russian gunboat, the Svetch, 
 was inside. Sunset fell in perfect rest on a prospect 
 as rich and peaceful as that on which it might have 
 fallen eight hours after on the wold of Sussex or the 
 Yorkshire moors. 
 
 A British official of the Russian municipality took 
 me in charge. The river was crossed in a sampan 
 after a hard pull, or rather a shove with the stern oar, 
 against a five-knot current, in and out through the 
 junks moored three abreast along the bank, up to the 
 Customs' quay. A sentry challenged the approach 
 of our craft out against rules after dark. Hardly 
 anyone was to be seen ; the hotel was full, mostly 
 with Russian officers, whom we saw playing bil- 
 liards through the open window ; and finally my 
 companion, with the kindness characteristic of an 
 exiled Briton, carried me off to his own house. 
 
THE EVACUATION OF NIU-CHWANG 197 
 
 On Saturday, the 23rd, we awoke to the distant 
 sound of guns, which had been firing continuously, so 
 said the Sikh watchman, since four o'clock. Climbing 
 up two flights of stairs and a ladder, we perched our- 
 selves on bags of grain across the ridge of the roof and 
 looked out for signs of the fight. Ever}/ now and 
 again a small patch of smoke against the dark green 
 of the nearest hills enabled the site to be determined 
 as from ten to fifteen miles to the south of the railway 
 junction at Ta-shih-chiao ; but little could be seen 
 all day, and the firing continued with intervals of 
 only half-an-hour or so until seven o'clock. There had 
 been a big battle, it was reported, with 3000 casual- 
 ties on the two sides, and the Japanese were still eight 
 or ten miles from the junction, so that Russian com- 
 munication with Liau-yang and Mukden was still 
 intact. Would their enemy rest another fortnight, 
 as usual, before facing another action, or would they 
 press on at once and take Ta-shih-chiao ? The 
 question was much debated ; for 40 or 50 Russian 
 cavalry appeared in town, and it was said, it appears 
 with truth, that they belonged to the main army, 
 from which they had been cut off by the Japanese. 
 On the other hand, the Russian officials showed no 
 signs of impending danger, and there were no obvious 
 preparations for withdrawal. The Russian Ad- 
 ministrator, to whom I applied for leave to visit the 
 hospitals at Liau-yang and the front, gave some 
 hope of such leave being granted, although it was 
 useless, he said, to telegraph for permission until the 
 present battle was over. He was asked permission 
 the next morning. 
 
198 HEALTH AND EMPIRE 
 
 But on Sunday morning the firing began again 
 at five o'clock with increased severity. Every roof 
 was crowded, and on the roof of the still incomplete 
 Administration Building we were a fine motley of 
 European nationalities, mixing with the Russian 
 officers in uniform and the better-class Chinese. 
 
 The shell-fire was now to a large extent on our side 
 of the hills ; every other shot heard was represented 
 by a puff or puffs of smoke, and as all but horse 
 batteries in the Russian artillery had eight guns, and 
 the Japanese had six, and as the batteries or half 
 batteries often fired volleys, it was possible to dis- 
 tinguish to some extent between the two armies. 
 
 During the morning the artillery duel advanced a 
 little towards Ta-shih-chiao, but in the afternoon it 
 reappeared ten or twelve miles away, while towards 
 evening soldiers were seen pressing right over the 
 hills behind that is, on the east side of the railway 
 junction. We hear now that the whole of this 
 artillery duel was a feint rather than an attack on the 
 part of the Japanese to retain the greater part of the 
 Russian forces, while most of General Oku's army 
 from the south pressed round to the east to join in 
 the attack on Liau-yang and cut off the Russian 
 retreat. That a considerable battle was taking place 
 around Liau-yang, with General Kuropatkin him- 
 self in command, was not concealed by the Russian 
 officials in Niu-chwang ; but still there was no sign 
 of their leaving the town. For an hour or more the 
 doctor attached to the administration, a lieutenant- 
 colonel in their medical service, was telling me about 
 their hospital arrangements over a cup of tea, and 
 
THE EVACUATION OF NIU-CHWANG 199 
 
 talking in French or fluent English, rather than in 
 Russian, with Prince Jaime de Bourbon, Don Carlos' 
 son, who for eight years had served in a Russian 
 cavalry regiment, and was now in the town awaiting 
 orders. Firing never stopped all day except for a 
 few minutes. Morning service in the graceful little 
 English church, with doors open, was conducted 
 to the accompaniment of gun-fire, a few Russian 
 soldiers coming in, in khaki, and sitting on the steps 
 of the font, at the west end. As the sun fell the flash 
 of bursting shells became obvious rather than the 
 smoke the position appeared unchanged ; Ta-shih- 
 chiao had evidently not fallen and by nine o'clock 
 all was still again. 
 
 The next morning, Monday, 25th July, we were 
 roused at six o'clock by the news that the Russians 
 were gone. Many, indeed, were gone, and the last 
 train had left Russia-town at five, with what fate I 
 never heard. We mounted again to the housetops, 
 and between seven and nine there passed out along 
 the road at our feet the remaining Russian infantry 
 and details, a stalwart-looking set, fine marchers, 
 but thickly clad the same for winter and summer, 
 they say with a heavy coat, rolled over one shoulder 
 and under the other, and many pounds of kit hung 
 about them. The temperature these days had been 
 98 in the shade, and the air was always moist. 
 Away up the river, headed by the Svetch, steamed 
 the seven Russian launches ; and Niu-chwang was 
 evacuated. The civil officials remained, but the flag 
 hoisted at eight o'clock over the Administrator's house 
 was no longer the national but the commercial flag. 
 
200 HEALTH AND EMPIRE 
 
 The Russian Administrator was now only one out of 
 many consuls. Finally at eight-thirty A.M. there arose 
 over Russia-town, three miles off, a dozen points of 
 flame and a dozen pillars of dense white smoke, 
 which gradually merged themselves into one vast 
 cloud, blotting out a third of the landscape, right up 
 into the clouds. The lesson of 1812 still lives. 
 
 It is difficult for those at home to realise the 
 anxiety of the situation that now presented itself 
 to the residents. The Russians had completely 
 evacuated the town, offices, barracks and fort. The 
 Japanese were still far off and might not come for a 
 couple of days. Here in Niu-chwang was a popula- 
 tion of 7000 Chinese or more, containing, it was 
 known, a large number of former Boxers and Chun- 
 chuses, the brigand guild of North China ; large 
 bodies of Chunchuses were known to infest the sur- 
 rounding neighbourhood, and would certainly have 
 seen the smoke of Russia-town and have read the 
 meaning of the sign. Chinese official authority had 
 long been crushed out of existence. The 500 native 
 so-called police would be little able, if willing, to stop 
 any serious mischief. There was not a gunboat 
 nearer than Ching-wang-tao, eighty miles off down 
 the Gulf of Pechili, whither H.M.S. Espiegle had 
 retreated two or three months before, when not 
 allowed by the Russians to stay at Niu-chwang. 
 The local volunteers, useful enough during the 
 Boxer outbreak, had long ceased to exist. It was 
 necessary, therefore, for the consular body and the 
 leading residents to combine in improvising measures 
 for the defence of the European settlement in case 
 
AN EPISODE IN THE RUSSO-JAPANESE WAR. 
 
 
 (a) The First Japanese Scouts into Ninchwang. 
 (6) Russian Forage Smouldering and Chinese Junks waiting for Loot. 
 
THE EVACUATION OF NIU-CHWANG 201 
 
 of trouble, leaving the police and the Chinese mer- 
 chants' guild to look after the Chinese town ; and 
 meanwhile to despatch messengers on foot, horse- 
 back and bicycle to inform the Japanese of the 
 evacuation and to ask some officer of sufficient 
 authority to occupy the town as soon as possible. 
 On Mr. Millar, the American Consul, who had recently 
 presided over the court which sat in the case of the 
 murder of Mr. Louis Etzell, fell the responsibility, 
 as senior consul, of initiating proceedings. Mr. 
 Little, the British Consul, telegraphed to the British 
 Minister at Peking ; but the Espiegle at Ching- 
 wang-tao would take six or eight hours to arrive, 
 even after receiving sailing orders, and getting up 
 steam, and on arrival might not be able to cross the 
 bar on the ebb-tide. One gentleman was appointed 
 head of a volunteer police force ; but most men had 
 wives or property of their own to protect, and 
 would not be able to leave their houses unguarded at 
 night. Messengers were sent out both by private 
 residents and the consular body, the heads of the 
 chief shipping firms, with good local knowledge at 
 their hand, being of chief assistance in arranging 
 these and other measures. Meanwhile the looting 
 was proceeding apace in Russia-town. Half the 
 sampans in port had spread their sails and sailed up 
 the river ; and after two o'clock four of us followed 
 them to find out what was doing. The sight was a 
 memorable one. Along the water's edge were moored 
 the junks and sampans, rapidly being filled with coal 
 and wood. In the water there floated odds and ends 
 of timber, a wardrobe, a dining-room table, with its 
 
202 HEALTH AND EMPIRE 
 
 new owner seated on it or wading or swimming be- 
 hind. On the banks of the river smouldered the 
 burning stacks of forage (Plate 13). In front of 
 the distillery and sheds there hacked and hewed 
 away at the coalsheds, as they had never worked 
 for wages, a number of naked or half-naked Chinese 
 coolies, filling their baskets and carrying them on 
 poles to be piled into the boats. Galvanised iron was 
 being stripped off the roofs of houses ; floors ripped 
 up ; doors and windows, and even window-frames, 
 wrenched away ; and no vestige of authority existed 
 to represent the law of property or the power of the 
 European. The houses and station buildings were 
 mere shells, untouched by fire, but swept of all else ; 
 and the only mementoes we brought away with us 
 were a torn playing card from the hotel, a bit of 
 wall-paper and an old telegram from the station. 
 The wooden church still stood, with its four small 
 Greek crosses on the roof ; but for all else it might 
 well have been a derelict barn, and the site of the 
 altar was marked only by a great gap in the wooden 
 floor, where the barbarians had evidently looked for 
 treasure. Here indeed was the Yellow Peril, man 
 naked and unashamed, the savage free to make 
 havoc and seize his booty, untrammelled by any law 
 or responsibility. But here, on the other hand, was 
 the retribution of wrongdoing in nations pictured 
 most vividly in a single scene. The massacre of 
 7000 Chinese in the Amur at Blagovestchensk at 
 the outset of the Boxer trouble had met its 
 reward. 
 
 By four o'clock we were baek to welcome the first 
 
THE EVACUATION OF NIU-CHWANG 203 
 
 five Japanese scouts on their sturdy, shapely, healthy 
 ponies, about 14 hands high, none the worse for 
 the heavy weights they had to carry (Plate 13). The 
 men themselves, dressed in khaki, with blankets, 
 peaked caps and yellow puggarees, breeches and 
 light-built riding boots, armed with sword and car- 
 bine (one we noticed blood-stained) could have stood 
 only 5 feet 6 inches or so high ; but with saddle- 
 bags, forage-bags, coats, well-filled haversacks, they 
 must have ridden 14 or 15 stone. The first had 
 been met, finding his way without the least diffi- 
 culty with a complete map of the neighbourhood, 
 although totally ignorant of Chinese. Making their 
 way straight to the Administrator's house, they were 
 surprised to see the Russian flag lowered and the 
 French flag hoisted before their eyes, and on halting 
 in front of the gates they received the welcome of 
 the Chinese Guild ; while the guards set to work to 
 free the recent Russian military headquarters an 
 old Chinese temple of their remaining contents. 
 
 By nine o'clock 50 Japanese cavalry had already 
 halted by the house of one of the chief residents, 
 who had played a leading part in the day's proceed- 
 ings, while his wife was fortunately able, with a 
 fluent knowledge of Japanese, to act as interpreter. 
 
 Mr. Victor Grosse, the able Administrator, who for 
 the last two years had won the respect and esteem of 
 all residents, independent of nationality, remained, 
 although in mufti, under the protection of the French 
 flag, and refused to meet the Japanese officers. The 
 personal sympathy felt for him in the circumstances 
 was as^universal as were the relief at the appearance 
 
204 HEALTH AND EMPIRE 
 
 of the Japanese, the general admiration at the 
 success of their troops and the preference for their 
 public policy. A few other officials remained ; but 
 almost all the Russian civilian population, including 
 the staff and treasurer of the Russo-Chinese Bank, 
 had moved across to neutral territory on the other 
 side of the water, where in the station rest-house they 
 awaited the next train for Taku and Tien-tsin. 
 Many unfortunate Russian and other white women, 
 urged by terrible details told them by the Russian 
 troops before leaving, as to the maltreatment and 
 mutilation of their kind by the Japanese absolute 
 falsehoods, we may well believe had in the early hours 
 of Monday morning, in varying degrees of deshabille, 
 already crossed the river. For fear of the Chun- 
 chuses hardly a native was visible out of doors ; and 
 it was with difficulty that a sampan was found on the 
 left bank of the river to take me out to the steamer 
 which carried myself and this letter with break of 
 day and turn of tide down to Chifu. 
 
CHAPTER XI 
 
 A VISIT TO SASEBO THE NAVAL HOSPITAL OF JAPAN 
 
 {Reprinted by kind permission from " The National Revieiv ") 
 
 SASEBO is the chief naval base of Japan, possessed of 
 a large, deep and completely land-locked harbour 
 and closely surrounded by fortified hills. The mouth 
 of the harbour opens deviously and picturesquely on 
 the west coast of Kiushiu, the first large island of 
 Japan that a ship touches in coming up from Shanghai 
 or across from Chifu, Tien-tsin or Port Arthur. 
 
 It was therefore only two days' journey at 
 most for the sick and wounded of Admiral Togo's 
 fleet to be comfortably transported in the Kobe 
 Mam or the Saikio Maru the hospital ships belong- 
 ing to the Japanese navy to the ample comfort 
 and professional skill of Surgeon-General Totsuka 
 and his base hospital at Sasebo (Plate 14). The 
 traveller, however, reached it only by a five hours' 
 journey northward from Nagasaki or seven hours' 
 down from Moji in the Straits of Shimoneseki ; and 
 then he was admitted only as an exceptional favour 
 with a permit from the Minister of Marine at Tokyo. 
 Sasebo, moreover, was under martial law and every 
 foreigner on the railway was closely cross-examined 
 by the police. Few foreign visitors had visited the 
 town, but amongst them must be reckoned the crews 
 205 
 
206 HEALTH AND EMPIRE 
 
 of a good many British colliers, twelve of which 
 were in harbour in August, 1904, on the day of the 
 visit described in this chapter. The other chief 
 naval stations and the only other naval hospital 
 of importance were in the Inland Sea a hospital 
 with thirty beds at Kure, where the first two 
 ironclads built in Japan had recently been laid 
 down a large naval station, situated an hour by 
 boat or rail south of Hiroshima. Hiroshima, on the 
 other hand, three days' journey by sea from Port 
 Arthur, was the chief military medical base, with 
 hospitals for 4000 sick and wounded, from which the 
 slighter cases and the convalescent were drafted on 
 to Tokyo or Osaka, while the Russian prisoners were 
 taken straight to the equally admirable hospital and 
 prison quarters at Matsuyama in the island of Shikoku, 
 which closes in the Inland Sea from the south. 
 
 The Unique Features of Modern Naval Surgery. The 
 essential feature of the work at Sasebo naval hospital 
 was that 90 per cent, of the cases of ordnance-wound 
 were inflicted by shell and not by bullet. Here then, 
 for the first time in history, the science of shell- 
 wounds was being studied under good modern 
 conditions. For in South Africa hardly 5 per cent. 
 of wounds, even early in the war, were inflicted by 
 shell, and these were scattered up and down the 
 country through a dozen different hospitals, so that 
 a concrete study of their peculiar features was 
 impossible. In the Spanish- American and Chinese 
 wars there were few casualties from artillery ; and 
 earlier wars furnished as little experience for the use 
 
A VISIT TO SASEBO 207 
 
 of the modern surgeon as for that of the modern 
 artilleryman. During the first six months of the 
 Russo-Japanese War 180 cases of naval shell-wound 
 had survived to reach Japan. The report therefore 
 of the medical department of the Japanese navy at 
 the conclusion of the war will have made in this 
 respect a definite addition to surgical science. The 
 three surgeons-general of the navy know English 
 well, and will, it is to be hoped, issue a report in our 
 language on the precedent of their valuable report 
 after the war with China in 1894. The Director- 
 General, Baron Saneyoshi, was educated at St. 
 Thomas's Hospital, and is a Fellow of the Royal 
 College of Surgeons of England. In both of these 
 spheres he is on common ground both with Surgeon- 
 General Totsuka and with one of his predecessors, 
 Dr. (now Baron) Takaki, who at the age of twenty-five 
 became Director-General of the Medical Department 
 of the navy, improved the rice-diet and stamped out 
 the scourge of beri-beri from the ships in introducing 
 a thorough system of sanitation. 
 
 The director-general ranks as a vice-admiral with 
 two small stars on a broad gold stripe down the 
 shoulder-strap. The other two naval surgeons- 
 general rank as rear-admirals, with one star on a small 
 stripe of gold ; and medical officers of lower degree 
 are called doctor, rank with captains, commanders 
 and lieutenants according to seniority, and wear the 
 corresponding marks of rank. 
 
 The difference between explosive shell-wounds and 
 bullet-wounds is absolute. The effect of the bullet 
 depends upon what important structure it may 
 
208 HEALTH AND EMPIRE 
 
 strike bone, nerve, artery or internal organ. If it 
 pass through flesh only and strike no such structure, 
 and if the wound be kept clean from the first, the 
 patient is perfectly recovered in a few days, the 
 wound healing by primary intention. The effect of 
 the explosive shell, on the other hand, is a laceration. 
 The wounds of those who survived to reach Sasebo 
 were either surface wounds or mutilations of a whole 
 limb. The treatment is usually that of any other 
 surface injury or else amputation. Shrapnel- wounds 
 take an intermediate position. They are caused by 
 half-inch leaden balls, scattered in large numbers in 
 various directions on the bursting of the metal case ; 
 and owing partly to their comparatively small 
 momentum, partly to their rough, leaden surface, 
 partly to their having no screwlike rotary motion 
 which gives to the rifle bullet its great penetrating 
 power, and owing partly also to the particles of 
 sulphur in which they are embedded in the case, 
 they frequently remain in the body of the patient they 
 hit and introduce sufficient contamination to set up 
 suppuration, abscess and occasionally blood-poison- 
 ing. Put tersely, then, the bullet-wound is a shot 
 through a roomful of machinery ; the shell-wound 
 is an explosion in or near the machine-house ; the 
 shrapnel is a lucifer match thrown in through the 
 window. 
 
 Cases of gunshot or shrapnel wound in the navy of 
 to-day must almost invariably indicate fighting on 
 land, and these cases at Sasebo were incurred by men 
 landed from the ships to assist in the fighting round 
 Port Arthur. It is seldom now that men-of-war 
 
A VISIT TO SASEBO 209 
 
 approach each other near enough to make it worth 
 their while to fire shrapnel. For the object of shrap- 
 nel is to kill or wound men, not to injure ships, and 
 the aim in modern fighting on sea is essentially to 
 sink or damage ships. In Nelson's days naval 
 battles were necessarily at close quarters, and it was 
 an attainable object to sweep the decks and to tear 
 the sails and riggings with musket and grape shot 
 and with cannon ball so as to deprive the ships of all 
 control. But now, with torpedoes and long-range 
 rifled guns, with machinery instead of sails, and the 
 whole protected 'neath decks below the water-line, 
 or in armour-plated bulwarks, conning-towers or 
 barbettes, the only methods of disabling a ship are to 
 ram, torpedo or to breach the steel protection and 
 damage the contents with heavy shell. Wounds 
 on board ship, therefore, are usually the result of 
 ragged splinters and sections of shell. But torpedo 
 craft, with plating only ^--inch thick, offer little 
 protection to their crews and may occasionally be 
 subject to raking shrapnel fire. 
 
 A Few of the Cases. The only case of shrapnel- 
 wound that detained us at Sasebo was that of a man 
 hit a fortnight previously in the fighting round Port 
 Arthur, in which the shrapnel-shot passed in behind 
 the shoulder and lay buried there. It was extracted 
 and the patient was in a fair way to recovery. An- 
 other shrapnel-shot had passed through the flesh in 
 front of his elbow without touching bone, nerves or 
 artery, and had made its exit without causing any 
 serious damage. There was not a single case in the 
 
210 HEALTH AND EMPIRE 
 
 hospital of a penetrating wound of the abdomen. 
 Head wounds were limited to wounds of the scalp 
 or fracture of the face-bones. There was one case 
 in which a depressed fracture of the skull had been 
 successfully treated by operation. During the first 
 six months of the war there had been two cases of 
 chest wound in which bullet or shrapnel had remained 
 in the chest and were extracted, two or three in which 
 they had passed out again. The other cases noted 
 were all of limb wounds. G. Ishii of torpedo boat 
 No. 67 had been severely wounded by shell in the 
 month of May. A photograph showed clearly what 
 his original condition had been, with the humerus 
 broken, nerve severed, causing paralysis of the hand 
 and a gaping wound a foot long on the outer side 
 and back of the arm. Amputation had been neces- 
 sary, and now, early in August, the man was sitting 
 up comfortably in bed with the wound healed, wait- 
 ing for his artificial limb. One other case of a stump 
 after amputation was pointed out. The leg had 
 been well amputated through the knee-joint, and the 
 artificial limb, light and well-made, with good thigh 
 piece, waistbelt, knee, ankle and foot joints com- 
 plete, had just been tried on for the first or second 
 time. These limbs are presented by the Empress, and 
 are made of course in Japan, whose carpenters, 
 joiners and cabinetmakers are perfect craftsmen, 
 especially in bamboo. 
 
 But very few cases had been serious enough to 
 need amputation, from which fact two inferences 
 may be made : firstly, that few hopeless lacerations 
 of the limb survive ; and secondly, that conservative 
 
A VISIT TO SASEBO 211 
 
 surgery is now an attainable ideal in almost all cases 
 that reach hospital. The myth that surgery on the 
 battlefield consists of amputations and ligature of 
 arteries is fully exploded. 
 
 The Rarity of Death. Five fatal cases had occurred 
 in the hospital during the first six months of the war. 
 Deaths, it is commonly understood, are now of rare 
 occurrence on the surgical side of a military or naval 
 hospital, a change due to Lister's and Pasteur's 
 work. And the further removed a base hospital is 
 from the scene of operations the more complete should 
 be the sifting out of serious cases before the remainder 
 are sent down the line or across the sea to the base. 
 But this applies less to sea than to land ; for the 
 wounded at sea find the analogue of a field-hospital 
 in their hospital-ship, which might just as well 
 convey them to the base as remain with them in the 
 neighbourhood of naval operations. Indeed, hospital- 
 ships and hospital-trains might well be equipped and 
 scheduled as mobile field-hospitals ; and the twenty 
 luxurious hospital-trains on the Russian side in 
 Manchuria were so equipped, with operating-rooms, 
 baths, kitchens and quarters for a full staff as well as 
 for no less, on the Czarina's magnificent train, than 
 200 lying-down and 200 slighter cases, as compared 
 with the 100 odd that were taken by each of our 
 five hospital-trains in South Africa. Thus one of 
 the patients who died at Sasebo, M. Ono of the Fuji, 
 was able to be transported by ship although suffering 
 from a shell-wound to both legs, resulting in double 
 gangrene and death. If anything could have saved 
 
212 HEALTH AND EMPIRE 
 
 him it could have been done in transit in the operat- 
 ing theatre of the Saikio Mam. 
 
 Shell-burns. Shell-wounds, then, are mostly lacera- 
 tions of the soft tissues. But there is another effect 
 which comes into increasing significance with modern 
 artillery. When a shell bursts, all men within a 
 radius of several yards are in severe danger of burns 
 from the explosion. When watching the two days' 
 artillery duel at Ta-shih-chiao near Niu-chwang on 
 23rd and 24th July, every explosion towards dusk 
 seemed to us, fifteen miles away, as a flash of light 
 half as high as the hills on which it exploded, and as 
 broad as it was long. Although the duration of this 
 light cannot have been one-fifth of a second, yet its 
 brilliancy and extent suggest the injury it may inflict. 
 At Sasebo they had a large number of cases in which 
 burns had complicated wounds or had constituted 
 the sole injury. These burns were clean, at least to 
 the naked eye, and not of great depth ; they were 
 treated like ordinary burns and redressed with 
 aseptic gauze every other day. They had healed well, 
 and so far there had been no case of complication or 
 after-effect. The scar was simply lighter in colour 
 than the surrounding skin. 
 
 The Red Cross Society at Work. One man who had 
 suffered from clean-cut wounds, now healed, behind 
 the elbow and shoulder, had probably been struck 
 by shrapnel. He belonged to the Shikishima and 
 was one of the many hundreds who volunteered and 
 of the few who were selected to take the six tramp- 
 
A VISIT TO SASEBO 213 
 
 steamers into the mouth of Port Arthur and to sink 
 them there in a perfect typhoon of artillery from 
 ships inside and forts above. He survived, however, 
 to be nursed by Mrs. Totsuka, wife of the Surgeon- 
 General. This lady wore the serviceable white 
 uniform of all who nurse under the Japanese Red 
 Cross. The female nurses employed in the military 
 and naval base-hospitals and ships for none 
 served in Manchuria were all engaged and paid by 
 the Red Cross Society of Japan. Many Japanese 
 ladies were also in this war for the first time admitted 
 to help in the work, although their trained assist- 
 ance was soon restricted to the rolling of bandages 
 and the preparation of first field-dressings, little 
 packets that are sewn into the tunics of every 
 soldier when he goes on active service. The social 
 importance of this development can hardly be appre- 
 ciated in England. Nursing in Japan has long been 
 a tradition of Japanese women, but of women only 
 of the lower classes. Considering that the feudal 
 system was abolished only forty years ago, it is not 
 surprising to find that hitherto there has been little 
 mixing of the classes. For ten years, however, the 
 Ladies' Volunteer Nursing Association, working under 
 the control of the Red Cross Society, had been busily 
 engaged in raising the credit of the nursing profes- 
 sion. Every day of the week during the war the 
 ladies of Tokyo worked at the Red Cross Hospital, 
 Europeans one day, Japanese five days a week ; 
 and it was an interesting sight on a fine July after- 
 noon to see fifty of them of all ranks from the 
 Princess Nashimoto and Baroness Nobeshima, her 
 
214 HEALTH AND EMPIRE 
 
 mother, downwards in their white cotton uniforms 
 and caps busily engaged in rolling bandages. Twenty 
 thousand of these bandages had recently been sent out 
 on the Hitachi Maru and sunk by the Vladivostok 
 squadron ; but the ladies with characteristic courage 
 set to work, now at seven o'clock each morning, to 
 roll 20,000 more bandages a somewhat typical 
 incident in this war. 
 
 It was interesting again on another day to attend 
 a meeting of Japanese ladies at the Red Cross depot 
 on the ist July, where upper and middle classes met 
 to be instructed in bandaging the dummy by a 
 retired, white-bearded army doctor. A roof and a 
 raised floor ; a crowd of Japanese ladies in their 
 sober mauve or grey kimonos standing round the 
 easel, blackboard and dummy; the quiet, con- 
 ventional garden outside ; the alcove in which three 
 of the princesses sipped tea afterwards with a lady-in- 
 waiting and shook hands with the foreign visitor ; 
 the court ladies talking freely with all comers when 
 the demonstration was over; the delicate models 
 on a side table of every kind of improvised stretcher 
 and apparatus for carrying the sick and wounded 
 such a scene could not fail to strike the least vivid 
 imagination with a sense of its many-sided import- 
 ance. 
 
 Nursing in Japan. The Red Cross uniform for 
 nurses was simple, clean and neat, consisting of a 
 white cotton overall, tied with a cotton sash round 
 the waist, and a high starched cap, which, although 
 not becoming, had the merit of confining those stray 
 
A VISIT TO SASEBO 215 
 
 locks that prove a source of anxiety to the aseptic 
 surgeon. This cap usually bore over the forehead 
 the distinguishing mark of a plain red cross. There 
 were no English nurses in the Japanese hospitals, 
 and none were wanted. One English lady a British 
 officer's widow had contrived in her enthusiasm to 
 be employed in elementary work at Tokyo ; fifteen 
 American nurses, headed by Dr. Miss Gee, found 
 employment at Hiroshima. But the difference of 
 language, custom and food entailed endless complica- 
 tions ; and, except in scientific knowledge, which can 
 only be gradually and systematically acquired, the 
 westerners had not much to teach the dainty-fingered, 
 patient, light-hearted little nurses of Japan. The 
 Red Cross Society numbered on its books, in the 
 summer of 1904, 2391 nurses, 717 male attendants 
 and 150 stretcher-bearers ; and more were without 
 doubt under training, sufficient for all probable 
 demands. Moreover it must be remembered that 
 the Japanese work willingly for almost double the 
 eight-and-a-half-hours' day which is considered the 
 proper limit even in a London general hospital ; and 
 finally, the Japanese nation had determined to carry 
 this war through to a successful termination with 
 their own unaided resources for the sake of the 
 national credit. 
 
 Medical Aid for Japan. The same reasons applied 
 equally to the question of medical aid. An offer 
 made to the Japanese Government in August of 1904 
 to raise and take out to Japan a band of young sur- 
 geons from England, tojbe supported probably by a 
 
216 HEALTH AND EMPIRE 
 
 charitable fund in this country, as was done from a 
 fund raised by The Daily Chronicle in the Turco- 
 Greek War, was declined with thanks on the score of 
 such help not being required. The reasons given 
 above were doubtless largely responsible for this 
 decision. 
 
 The Hospital. The hospital at Sasebo, of 600 
 beds, in August, 1904, only half full, was built in ten 
 pavilions of light grey wood, plastered on the inside, 
 roofed in grey tile, simply floored in plain wood, 
 standing two feet above ground on brick foundations, 
 and connected by raised wooden corridors with over- 
 hanging roofs and wooden sides up to three feet from 
 the floor. The spacious operating theatre, simply 
 built with a proper view to light, space and cleanli- 
 ness, measured 20 feet by 30, with walls 12 feet 
 high and the unceiled roof rising another 8 feet 
 to the centre of the room. Commendation of a 
 cheap theatre may perhaps be challenged, but there 
 is without a doubt much to be said in favour of 
 simplicity in theatre-construction, seeing that, so 
 long as dust and rain are excluded, surgical infection 
 can only arise from unclean hands, unclean ligatures 
 or unclean dressings. If this be admitted, it is best 
 to have a cheap theatre which can be replaced at 
 slight cost to meet the varying needs of successive 
 surgeons and the successive stages of surgical opinion, 
 and can be multiplied so as to permit of each surgeon 
 having his own theatre, as he has his own wards. On 
 this view it is wanton waste to spend money on marble 
 halls with complicated patent tables and regal fittings, 
 
A VISIT TO SASEBO 217 
 
 as is too often the case in English hospitals -a relic 
 of the early days of the Listerian era, when hospital 
 gangrene was the chief foe of every hospital surgeon. 
 The simple type of theatre is that which, with the 
 partial exception of two in the University Hospital 
 at Tokyo, was universal in the poor and practical 
 country of Japan. Sweet are the uses of adversity. 
 
 Japanese Surgery. The methods of the Japanese 
 surgeons were those of the most advanced modern 
 surgery all the world over. For years they had been 
 trained mainly by Japanese and German professors, 
 had been obliged to learn one foreign language, the 
 one chosen being usually German, and had been 
 encouraged to visit the German hospitals. They 
 showed therefore the faults as well as the virtues of 
 German methods. The operative surgery in each 
 hospital was all done by the best surgeon, and not, 
 as in our better London system, by many rising 
 surgeons and capable students under the supervision 
 of the chief surgeons, a system which trains many 
 men to the best work and is probably to the actual 
 advantage of the patients. The Japanese surgeons 
 again followed the extreme modern school, whose 
 confidence in their ability to exclude all sources of 
 contamination from a wound was such that they 
 employed no antiseptics ; but to this end they had 
 to boil even the tap-water in which they washed 
 their hands. Experience, however, seems to show, 
 in Japan as in England, that this confidence is not 
 justified. One of their hospitals, at least, had had 
 more than its fair share of suppuration. In other 
 
218 HEALTH AND EMPIRE 
 
 words, the Japanese in this as in most departments 
 of modern knowledge had adopted the most appar- 
 ently thorough method known in Europe ; and they 
 lacked as yet the experience which should show them, 
 as it has shown us, where it is defective and must be 
 helped out by the older method, the use of anti- 
 septics. 
 
 A shipload of patients had just been admitted and 
 we went into the dressing-room to see the wounds 
 being carefully examined, diagnosed and recorded. 
 Thoroughness and care were again the dominant 
 notes. Everything was done promptly and effi- 
 ciently, without the least bustle, worry or assertion 
 of authority. Discipline in Japan is an instinct. 
 The Rontgen-ray room was well fitted up, without 
 superfluous complications and it was a fascinating 
 pleasure to watch the gentleness of the nurses in 
 arranging and supporting the crippled limbs and 
 patients for examination. 
 
 A large amount of the work of a naval hospital 
 even in war time results from accidents on board 
 ship, crushes and lacerations from machinery or 
 falling spars, engineering tools and parts of guns. 
 This affords, therefore, a good experience in fractures, 
 in which it was noteworthy that Dr. Totsuka had 
 almost abandoned the custom of operation, much 
 favoured by many advanced European surgeons. 
 The best splint-apparatus, however that of Hodgen 
 was apparently unknown, although in common use 
 in London. 
 
 The Medical Side. The medical side of the hospital 
 
A VISIT TO SASEBO . 219 
 
 was of little interest. The infectious ward was 
 empty. Most of the cases were those of diseases 
 common in peace time ; there were six of typhoid 
 fever, a few of mild dysentery, and the usual pro- 
 portion of internal disorders. Nursing the most 
 important agent after general health in the treatment 
 of disease appeared to be good, the staff consisting 
 of six male attendants under one chief attendant for 
 each ward, except in the case of two big pavilions 
 erected by the Red Cross Society, in each of which 
 36 patients, 12 of them in five or six small rooms at 
 the end, were nursed by a Red Cross sister and ten 
 nurses, who slept in a house outside the hospital. 
 The hospital contained cubicles for 20 officers besides 
 6 private officers' rooms. The medical staff con- 
 sisted of 12 surgeons, and their hours during the war 
 were from eight A.M. to six P.M. on all days, without 
 any interval or remission, however easy the work might 
 be. Much of their time was spent in the common 
 room ; but the regulation induced many officers to 
 find useful work to do that otherwise would not be 
 done. 
 
 This rough sketch of the naval hospital at Sasebo 
 would hold good also for the military hospitals of 
 Japan, and will give a fairly representative idea 
 of the principles that pervaded the medical work 
 both of their army and navy. They had little more 
 to learn from Europe, except the advantage of 
 delegating responsibility, to which reference has 
 already been made in regard to the surgeons ; they 
 had at least one supreme lesson to teach Europe 
 and ourselves in their absolute devotion to their 
 
220 HEALTH AND EMPIRE 
 
 work, their unprejudiced survey and adoption of 
 the world's knowledge, and the confidence that such 
 knowledge, systematisation and devotion had con- 
 ferred upon them. That lesson the British Empire 
 has yet to learn. 
 
CHAPTER XII 
 
 JAPANESE RED CROSS 
 
 THE RED CROSS HOSPITAL was four miles out to the 
 west of Tokyo and entirely the work of the Red Cross 
 Society, who in June, 1904, were building hard to 
 bring it up to 2000 beds. It had an imposing front, 
 built of red brick and stone, in two storeys, for offices, 
 stores, and class and committee rooms. The rest 
 was of wood. Precautions against fire were conspicu- 
 ously absent ; there were no buckets or hydrants 
 about, and Lieutenant-Colonel Hori, the kindly 
 surgeon who showed me round, said they were outside 
 the city limits and must depend on the military 
 in case of fire. Half the hospital, including single 
 and double rooms for 26 officers, and wards, all on the 
 ground floor in separate blocks, for 750 men, was 
 handed over to the army medical corps ; the other 
 half was worked by the Red Cross people themselves, 
 under general army medical direction. The brightly 
 polished black wood floors and posts and lacquer 
 furniture in the officers' rooms looked very well with 
 a few flowers, books and knick-knacks about ; but 
 the beds were old iron ones, of very heavy, primitive 
 and indifferent quality. 
 
 The patients saluted me most courteously and were 
 willing enough to talk about their wounds, through 
 
 221 
 
222 HEALTH AND EMPIRE 
 
 Colonel Hori, to whom they showed considerable 
 deference. The majority had fought at Nanshan, 
 the second great battle of the war. Most of the 
 wounds were all but well, and not of great interest 
 to the surgeon. There were a few longitudinal 
 wounds down the body or up the arm, received in the 
 act of charging, but there seemed to be few aneurisms 
 as yet. The most noticeable fact was that although 
 most of the men had small wounds quite healed, and 
 looked most robust and healthy, they were still to 
 be kept in hospital for two or three weeks, as being 
 better perhaps for their discipline and health than 
 convalescing at home. These men at Tokyo were 
 of course the slighter cases, filtered through the sieve 
 at Hiroshima, where all serious cases were kept until 
 quite fit to travel. 
 
 The men's wards contained wooden bedsteads, 
 close together, and little else ; all was of wood, clean, 
 neat and airy ; still more so the white-painted 
 passages. Allusion has already been made in a pre- 
 vious chapter to the difficulties of sewage disposal 
 in Japan, and this was more than exemplified, even 
 in the newest ward blocks of the Red Cross Hospital. 
 Otherwise it was hardly possible to find a fault. 
 
 One of the most striking objects I saw was a pair 
 of beautifully light Wellington boots for marching 
 half the weight of our " ammunition " boots, and of 
 course only half as durable a question, therefore, for 
 ordnance and transport to arrange, with sure military 
 advantage. When the Japanese soldiers had sore 
 feet on the march they were served out a pair of 
 sanitary socks, with the divided toe, and straw sandals, 
 
JAPANESE RED CROSS 228 
 
 which would tide over the period of treatment and 
 allow them at the same time to keep on the march, 
 the life of a sandal under such conditions being 
 accurately known. 
 
 The question of boiled water on the march came 
 up in the course of my visit. One had heard much as 
 to the discipline of Japanese soldiers, boiled water 
 being provided for every man's bottle each morning 
 and at intervals along the line of march, with the 
 strictest orders against drinking from any other 
 source. The Japanese colonel admitted that the 
 flasks became emptied on a long day's work, often 
 without any opportunity of being refilled, and that 
 then the men probably had resort to ordinary pools ; 
 but he thought this occurred only seldom. In any 
 case there seemed to be very little typhoid fever, only 
 a little enteric and dysentery, and no typhus, as had 
 been reported, or other epidemic, at the front. 
 Lieutenant-Colonel Macpherson's official medical and 
 sanitary report in 1908 on the Russo-Japanese War 
 a well-illustrated and most unofficially interesting 
 book bears out this report. Tired and thirsty 
 soldiers might occasionally escape the vigilance of 
 officers and water-sentries and drink from an unpro- 
 tected well ; but as a rule cleanliness was so ingrained, 
 the regular lectures on health, even in the field, were 
 so appreciated, the disgrace of illness from any pre- 
 ventable cause was so clearly recognised, that disease 
 was far less rife than might have been expected from 
 the hardships and exposure endured. It is interest- 
 ing to find that Colonel Macpherson gives the sickness- 
 rate per 1000 per annum of the Japanese forces in 
 
224 HEALTH AND EMPIRE 
 
 Manchuria as 590 as compared with a rate of 727 for 
 our forces in South Africa, although the Japanese 
 death-rate from disease was 41 as compared with our 
 South African rate of 24. 
 
 At the close of the tour round the hospital we ended 
 up in one of the committee rooms, where the European 
 ladies, under the Red Cross Society, were busy rolling 
 long gauze bandages, first by hand and secondly on 
 machines nice and tight but too long for our ideas 
 about ten yards. Every day ladies were at work 
 the Europeans one day, the Japanese five days a 
 week, a most convenient way of keeping them busy 
 and useful. The cynic might remark that it would 
 save both time and trouble for the ladies to subscribe 
 for the bandages ready-rolled ; but this would over- 
 look the main object of a Red Cross Society, which is 
 that of utilising, if not at cost price, then with as little 
 extravagance as possible, the available labour of 
 the voluntary helpers, especially ladies who wish with 
 their own labour to help their countrymen in the field. 
 Thus the authorities had come to terms with the 
 Red Cross Society, and the ladies working under it 
 sent off a few weeks before my visit 20,000 bandages, 
 the result of months of work. Their bandages, as 
 has been already related, had all gone down in the 
 Hitachi Maru ; and so the ladies with courage had set 
 themselves to work again, starting at seven o'clock 
 every morning. 
 
 They were dressed in uniform white overalls and 
 caps they had to scrub and sterilise their hands 
 carefully beforehand ; and the bandages were steril- 
 ised both before and after being rolled. These were 
 
JAPANESE RED CROSS 225 
 
 all untrained ladies, under the supervision of one or 
 two trained nurses, but there were some ladies with 
 a little hospital training who were allowed to make 
 " first field-dressings " in a special room for the 
 purpose. 
 
 I was given one of these first field-dressings to 
 tell the truth, a poor affair, except that it cost four- 
 pence instead of our eightpence-halfpenny. Let it 
 be remembered that these first field-dressings were 
 sewn inside the coat of every soldier going into action. 
 They might therefore have to bind up the dirtiest 
 and most extensive wounds for many hours, perhaps 
 for more than a day, until the injured men could 
 reach proper surgical aid. In the first place they had 
 oiled paper with which to cover over the gauze 
 dressing on a wound. At Wynberg, in South Africa, 
 we early discovered the mistake of an impervious 
 dressing, bottling in often large accumulations of pus. 
 This oiled paper was in the centre of the packet in- 
 stead of outside it, where in our own field-dressing 
 we used to have a waterproof covering to preserve 
 its asepticity. The Japanese dressing again con- 
 tained only one safety-pin against our two. It con- 
 tained no strapping, which is by far the most efficient 
 means that can be given an uneducated man of 
 fastening on a dressing to his wound ; the gauze in the 
 Japanese article was a piece, instead of a strip which 
 might be wound round and round a limb, this helping 
 to keep it in position ; and, finally, the bandage was 
 of the obsolete triangular form, instead of a roller 
 bandage. At a subsequent visit to the Russian 
 prisoners' hospital at Matsuyama, Surgeon-General 
 
226 HEALTH AND EMPIRE 
 
 Kikuzi, a Fellow of our Royal College of Surgeons, 
 took these remarks very kindly and appeared on 
 the whole to agree with them, so that it is possible 
 that the form of the first field-dressing in Japan may 
 latterly have been materially changed for the better. 
 
 What then is this Red Cross Society, of which they 
 talked so much during the war in Japan, and which 
 appeared to include in its organisation, in one capacity 
 or another, almost the whole population who were 
 unable personally to go into the field ? The society 
 had its origin in the " Haku-ai-sha," or Society of 
 Benevolence, founded during the Satsuma Rebellion 
 in 1877 for the purpose of giving relief to the sick and 
 wounded soldiers without distinction of parties. 
 
 This rebellion was the last smouldering embers of 
 Japanese tory dissatisfaction with western reforms. 
 In the year 1854 the first treaty with the United 
 States was concluded, and in the year 1863 a British 
 squadron bombarded Kagoshima as a punishment 
 for the murder of Mr. Richardson, who had made the 
 mistake of intruding near Yokohama upon the 
 Daimyo of Satsuma's retinue. Thenceforward the 
 province of Satsuma, in the south- westernmost corner 
 of Japan, became the centre of political activity, the 
 feudal chiefs in the island of Kyushiu maintaining 
 their positions with much pomp and circumstance. 
 This and the fighting qualities of the Satsuma men 
 led to the Revolution of 1868, and the overthrow of 
 the Shoguns or Prince-Regents of Japan, whose 
 authority the Southern Japanese resented. But the 
 same qualities induced still further dissent from the 
 Europeanising policy which followed the resumption 
 
JAPANESE RED CROSS 227 
 
 by the Emperor of his proper power ; and so Saigo 
 Takamori went out in rebellion, only to be suppressed 
 after eight or nine months' active warfare, when the 
 town of Kagoshima for the second time fell a prey to 
 the flames, and Saigo, fighting bravely on a hill 
 behind the town, saw that all was lost, and committed 
 harakiri. 
 
 In the eyes of the law, the Kagoshima fighters were 
 rebels ; many battles, great and small, had been 
 fought between the insurgents and the imperial arms ; 
 and the numerous sick and wounded on both sides 
 were almost untended. It is a striking tribute to the 
 humane virtues, which are often wrongly denied by 
 western writers to the Japanese, that the association, 
 first organised by four of the Japanese nobility for the 
 care of wounded, should have resolved on the funda- 
 mental principle of treating patients regardless of 
 party the outstanding principle of all Red Cross 
 work. 
 
 It may be pointed out here that Red Cross work 
 and the work of an army medical corps are different, 
 both in principle and in practice. Their divergent 
 aim is only now, with the advance of science and the 
 experience of recent wars, coming to be recognised. 
 The main principle on which an army medical corps 
 must work is that of assisting in the first instance to 
 maintain and increase, from a medical point of view, 
 the fighting efficiency of the army ; the guiding 
 principle of a Red Cross Society is the humane 
 desire to diminish suffering at all costs. Now in 
 practice it is clear that both the army medical corps 
 and the Red Cross Society work with both ends in 
 
228 HEALTH AND EMPIRE 
 
 view. The Red Cross people would naturally refrain, 
 unless they were singularly devoid of tact in which 
 case, as occurred occasionally in South Africa, they 
 would be made to refrain from any action that would 
 undermine the discipline of the army, or betray mili- 
 tary secrets. On the other hand, the army medical 
 corps, whose work is primarily that of preserving or 
 restoring to health, with a view to military efficiency, 
 the sick and wounded, would always, so far as possible, 
 give effect to their humane sympathies, and endeavour 
 to relieve suffering in every way. But, essentially, 
 the difference between the two branches of work 
 remains and has become more definite with each 
 successive campaign. Occasions may and do occur 
 when some sacrifice of life is necessary ; when the 
 wounded perhaps must be left for some time to take 
 their chance ; when the healthy, on the other hand, 
 may perhaps have to be restrained in their action for 
 fear of certain dangers to health. The advice of army 
 medical authorities and the work of an army medical 
 corps may therefore either lead to a greater freedom 
 of the military power, by relieving it of sick and 
 wounded, or it may involve a restriction of that 
 power as a safeguard against sickness. Above all, 
 their aim must be, as has been said, to maintain 
 a maximum physical efficiency in the fighting force, 
 and in organisation and methods of working to con- 
 form with perfect accuracy to the usual methods 
 of army organisation and army discipline. 
 
 It must be admitted that this was not the original 
 intention of supplying medical aid to our fighting 
 services. That original intention was the same as the 
 
JAPANESE RED CROSS 229 
 
 desire which inspired Count Tsunetami Sano and his 
 colleagues to found the Society of Benevolence, which 
 has become the Red Cross Society of Japan the 
 natural desire, that is, so far as is possible, to relieve 
 suffering. It was with this purpose that surgeons 
 were formerly appointed in the British army to live 
 and die with their regiments, and it is with this 
 purpose that the work of our Royal Army Medical 
 Corps often meets with the fiercest and most un- 
 deserved criticism, not only, I fear, in society and the 
 Press, who may be excused for being less well- 
 informed, but even in the army at large. 
 
 It was, on the other hand, by the growth of sanitary 
 science which the country owes very largely to Dr. 
 Parkes, a military surgeon in the Crimean War that 
 the strategic advantage of saving life, of preventing 
 disease, and of returning the wounded as soon as 
 possible to duty, was discovered ; and these dis- 
 coveries have shown without a doubt the necessity to 
 an army of prime attention being paid to this aspect 
 of medical work. It was in keeping, not so much 
 with this sanitary principle of strategy as with the 
 accompanying principle of conformity with military 
 procedure, combined with the advancement of 
 surgery, that led in our army to the organisation of 
 the Royal Army Medical Corps, with all its system of 
 separate medical units, corresponding to the military 
 units or stations, both in peace and war, and the 
 extinction as such of the friendly but professionally 
 decadent regimental surgeon. The change is cer- 
 tainly for the advantage of the patient in all serious 
 cases ; he is now no longer at the mercy of a man who 
 
280 HEALTH AND EMPIRE 
 
 may never have seen such a case since his hospital 
 days ; and, if time allow, he has at his command the 
 advice of specialists in all branches of modern 
 medicine. In dealing with large numbers of sick 
 and wounded in the field, often on the march, under 
 great difficulties of transport and sick accommodation, 
 efficiency is only possible through a properly organ- 
 ised service, and it is at the front that the essentially 
 military character of an army medical service should 
 prevail. 
 
 But at the base, on the other hand, in war, and still 
 more in peace, the two principles of military efficiency 
 and individual relief are closely intermingled. It is 
 well that voluntary agencies, which have only at 
 heart the individual relief, should be allowed here to 
 have full play ; for at the base-hospitals voluntary 
 agencies can be kept properly in check under super- 
 vision of the army medical corps, and to give such 
 free play is to the advantage not only of the patients 
 but also of the workers, the friends and relations of 
 their countrymen, anxious to share in the nation's 
 work. It operates also for the general welfare of the 
 nation in dividing responsibility with the public and 
 in giving a vent to feelings which would otherwise 
 result in much widespread discontent. 
 
 But voluntary agencies, when thus permitted to 
 share in the medical work of an army, should remem- 
 ber unfortunately they too often forget that uni- 
 formity is the essence of efficiency, and that their 
 own civilian efforts may be detrimental to the effect- 
 ive value of the army, may be a distinct hindrance to 
 their country's cause, if not properly surrounded by 
 
JAPANESE RED CROSS 231 
 
 safeguards which will keep the train on the rails. 
 Hence it is that military doctors exact and must 
 exact respect for their authority and rank ; hence it 
 was in South Africa that some of us young civilians 
 found that our soldier patients would unbend to us 
 as they would not unbend to the officers over us, and, 
 in consequence, that they treated us with greater 
 confidence and familiarity, and were correspondingly 
 lax in the observance of our rules. The voluntary 
 worker scoffs at the peremptory command, " 'Shun ! " 
 shouted by the sergeant when the major enters the 
 ward ; he derides the major's determination to have 
 each patient's boots in the exact spot prescribed by 
 the regulations ; he treats with some ridicule the 
 diet-sheets and forms by which his work is circum- 
 scribed. But, when the occupants of his ward return 
 to duty, it is the major-doctor that they will obey, 
 and not the civilian ; it is the major-doctor who will 
 be able to fit them to their kit, and estimate their 
 fitness to return to the ranks ; it is the major-doctor 
 who will err, if at all, on the side of strictness, in 
 order to brace his patients up for further military use ; 
 while it is the voluntary worker who will, without 
 thinking, do his best to get every patient a holiday 
 before he returns to duty. 
 
 Thus we see then the natural difficulties of em- 
 ploying voluntary aid in connection with the medical 
 work of an army, and we see the difference in prin- 
 ciple between the work of the official army medical 
 department and the voluntary Red Cross Sisters. 
 We see the need, in enlisting the help of voluntary 
 workers, of bringing their work into line with the 
 
232 HEALTH AND EMPIRE 
 
 usages, general administration and ultimate aims 
 of the army. 
 
 These principles are admirably preserved in the 
 constitution of the Red Cross Society of Japan. 
 When the Satsuma Rebellion was at an end the 
 Society of Benevolence made itself into a permanent 
 organisation and took steps to prepare for relief 
 measures in time of war. Nine years later, in 1886, 
 Japan acceded to the Geneva Convention, and the 
 Haku-ai-sha became the Red Cross Society of Japan, 
 with its Christian cross and all. This society is semi- 
 officially under the protection of the Emperor and 
 Empress, the honorary presidency of a prince of the 
 imperial house, and the management of a council, 
 including in its forty-four members several nobles and 
 gentlemen of distinction. The society is supervised 
 by the department of the imperial household, as well 
 as in other particulars by the army and navy. During 
 the Chino- Japanese War the society sent out over 
 1500 helpers, and during the Boxer outbreak nearly 
 500, to give relief to sick and wounded on both sides. 
 The experience of the former war resulted in the con- 
 struction of two hospital ships to transport patients 
 from the front to Japan. In this way, in the first 
 campaign 181,428 patients were relieved, nearly 1500 
 Chinese prisoners of war being brought over as 
 patients to Japan, and treated by the society ; while 
 in the Boxer trouble 11,348 wounded were relieved, 
 including 123 French and two Austrian patients, 
 who were brought to Japan from the allied forces. 
 
 The society does not confine its work to the calami- 
 ties of war, but has also displayed the greatest 
 
JAPANESE RED CROSS 238 
 
 activity in the disasters that afflict Japan more than 
 most countries in times of peace. In 1888, as a result 
 of the eruption of Mount Bandai, 140 miles north of 
 Tokyo, nearly 500 persons were killed and 40 
 wounded, and the Red Cross Society gave most useful 
 assistance. In 1891 a stupendous earthquake, which 
 laid waste two provinces in the centre of Japan, 
 accounted for over 7000 deaths and more than 11,000 
 injured ; the Red Cross Society at once rose to the 
 occasion with a couple of temporary hospitals, nine 
 ambulance carts and a small army of workers. 
 Inundations again are of almost annual occurrence, 
 and a tidal wave in 1896, which destroyed 20,000 
 houses and caused 21,000 deaths, as well as injuring 
 4000 people, was the occasion for the greatest relief 
 work done by the society in peace-time. Railway 
 accidents and fires supply other similar opportunities. 
 The decision whether relief shall be given or not in 
 case of any public calamity, and as to the way in 
 which such relief shall be given, rests with the chiefs 
 of local sections, assisted by the local councils. 
 Either the local section of the society or the local 
 authority may take the initiative. Food, lodging 
 and coolie labour for the use of the relief staff are 
 provided by the local authorities ; expenses, however, 
 even where the relief staff of neighbouring sections 
 is invoked, must be borne by the local section of the 
 society. Whatever use be made of its resources 
 in case of public calamity, it is laid down that no 
 interference shall be made with the preparations 
 for the fundamental object of service in time of war. 
 The society numbered in 1904 nearly 1,000,000 mem- 
 
284 HEALTH AND EMPIRE 
 
 bers, and is arranged in local sections, organised under 
 the general supervision of the central council in 
 Tokyo. 
 
 The Emperor and Empress, besides giving an 
 endowment producing 1000 a year, have so far 
 identified themselves with the work of the society 
 that it appears to be a matter of etiquette for all his 
 Majesty's representatives in official positions similarly 
 to give it their assistance. The royal patronage 
 has been exploited to its utmost extent. This patron- 
 age was explained to the prefectural governors in 
 Tokyo on the organisation of the society in 1887, 
 and the Marquis Ito, then Master of the Imperial 
 Household, enjoined them all to become chiefs of the 
 sections established in their respective prefectures. 
 The silver medal of membership is allowed to be worn 
 on public occasions by the side of State Orders, and 
 is considered a great honour ; a still higher decoration, 
 a Medal of Merit, is awarded to those who have 
 rendered special service in recruiting new members 
 or otherwise ; and the attractive force of these de- 
 corations, contrary to what one might expect in 
 Japan, is said to have been marvellous. The society 
 is further popularised by annual local assemblies 
 which have become the great social events of the 
 year, including exhibitions of work in field-hospitals, 
 with wrestling, fireworks and other entertainments. 
 The desire of the rural Japanese to see royalty is 
 shown by the fact that, when it was decided that the 
 honorary president could only attend the general 
 meetings of sections whose membership attained the 
 proportion of i to 100 of the population, the number 
 
JAPANESE RED CROSS 235 
 
 of such sections rose in three years from 4 to 28, 
 and at the time of my visit only 2 out of the 48 
 local sections were below the mark. The work of 
 the society had been made known, even in distant 
 villages, by the magic lantern, by various publica- 
 tions, and, for the previous fifteen years, by a monthly 
 magazine entitled The Japan Red Cross. 
 
 It will be seen therefore that the Red Cross Society 
 of Japan, although represented by local sections, is 
 well organised at the centre. Indeed it has the 
 advantage of having grown centrifugally, from the 
 centre outwards, instead of starting, as a large number 
 of local societies, with conflicting rules, and often 
 conflicting interests, which it might be extremely 
 difficult at a later period to reconcile and co-ordinate. 
 These two different systems in the formation of Red 
 Cross Societies were much discussed at the last 
 International Conference on the subject of Red Cross 
 work in St. Petersburg. The only effective argument 
 against centralisation is the lack of local interest 
 that may result from it. In Japan this interest, 
 as we have seen, is ensured by various social functions 
 and by the organisation of local sections, which, 
 moreover, arouse the greater local interest by their 
 active services in case of public calamity during peace. 
 In Russia, where the opposite system is in force 
 and the whole organisation is entirely decentralised, 
 two or more local societies may even exist in the same 
 locality, independent of each other, and the local 
 societies are allowed to spend their income as they 
 will. The result of this, as seen in Manchuria, was 
 undoubtedly a very great display of munificence 
 
286 HEALTH AND EMPIRE 
 
 in the provision of a large number of hospitals and 
 hospital-trains by Red Cross agency, but also, as 
 may be surmised, by absolute chaos. 
 
 Up to I5th July 1904 the Russian Red Cross 
 Society had sent 138 hospitals to the front, with 
 15,000 beds, 400 doctors, 1750 attendants and 800 
 Sisters of Mercy. Many of the best Russian families 
 had sent one member or more to aid in this beneficent 
 work of charity, and various officials on leave had 
 similarly assisted in the work ; but criticism, which 
 is one of the most useful results of war, showed that 
 there had been a great deal of peculation in the 
 management of Red Cross funds. The Moscow 
 branch had become a byword in this connection ; 
 and the Moscow merchants, and many private 
 individuals, Zemstvos and other associations it 
 was said preferred to equip their own hospital- 
 trains rather than entrust money for the purpose 
 to the Red Cross Sisters. Prince Tusupoff had his 
 own hospital-train running between Kharbin and 
 Mukden ; and the Empress herself had equipped 
 the most sumptuous train of which I have ever 
 heard, with accommodation for some 200 lying-down 
 patients, and an equal number of others, with swing 
 cots on springs, with baths, kitchen and operating 
 theatre, and complete arrangements for a staff of 
 4 medical officers, so many nurses and 36 attend- 
 ants on each train. Indeed, Dr. Kanal, a most 
 genial and courteous medical officer, ranking as a 
 lieutenant-colonel and attached to the administra- 
 tion at Niu-chwang, spoke with some contempt of the 
 superfluities of the Red Cross, just as one heard 
 
JAPANESE RED CROSS 287 
 
 similar complaints against some of the private 
 hospitals in South Africa. A Russian banker from 
 Kharbin had himself just seen their No. 20 hospital- 
 train, and described the luxuries with which it was 
 lavishly equipped. " How splendid," the tender- 
 hearted supporters of the Russian Red Cross, or of 
 the South African Imperial Yeomanry Hospital, 
 might exclaim, " to think that the poor fellows 
 will have every luxury that money can buy ! ' 
 
 But this is just one of the glaring fallacies from 
 which Red Cross work must, in order to be efficient, 
 be preserved by the army medical department. 
 Apart from the leakage of luxuries, of which many 
 instances could be quoted, the provision of extra 
 luxuries in private hospitals makes for discontent 
 amongst all patients who find themselves in the 
 military hospitals, and makes therefore against the 
 army medical department, weakening considerably 
 the hands and the hearts of its officials. There can 
 be no doubt that the only proper system is that of the 
 Japanese Red Cross, which co-ordinates all private 
 effort into one machine working directly under the 
 army medical authorities, an undertaking being given 
 that the equipment and supplies of the Red Cross 
 units shall be of the same kind only as those supplied 
 by government. Thus, all parts of the machine are 
 interchangeable. When stores give out in a Red 
 Cross hospital they can be supplied by government ; 
 when instruments or comforts are deficient in an 
 army medical hospital they can be replaced by 
 any that a Red Cross hospital may have to spare. 
 Here still is abundant scope for charity. If the 
 
238 HEALTH AND EMPIRE 
 
 government hospitals are not sufficiently comfort- 
 able, then they must be improved to equal the com- 
 fort which the Red Cross subscribers are allowed to 
 provide ; while, on the other hand, if the Red Cross 
 subscribers wish for further outlet to their charity, 
 they must find it in providing more hospital ac- 
 commodation on the same scale. Uniformity, as I 
 have already said, is the soul of military efficiency. 
 
 A further lack of uniformity in the Russian system, 
 to which we had some parallel in South Africa in the 
 case of Militia, Yeomanry and Volunteer Medical 
 Officers ordered out to the war, consisted in the 
 miserable pay 144 roubles, or 14 a month 
 allowed to Reserve Medical Officers drawn from civil 
 life, who had been excused military service in peace- 
 time in return for an unpaid liability to be called out 
 in time of war. Many of them had therefore been 
 obliged to throw up their practices, and for 168 a 
 year to support themselves on active service, and 
 their wives and families at home. 
 
 Not only had private charity in Russia during the 
 late war to cope with the difficulties of bad organisa- 
 tion and military apathy, but, when they took 
 matters into their own hands, the public had fre- 
 quently to face the often insurmountable obstruction 
 of peculant officials. An association of nobles in 
 the south of Russia so I was confidently informed- 
 equipped a special ambulance for the war ; all the 
 preparations were complete, and the train was ready 
 to start, but the requisite official permission was 
 repeatedly and for no given reason delayed. One of 
 the members of the association went personally to 
 
JAPANESE RED CROSS 239 
 
 St. Petersburg on the subject, and finally discovered 
 the cause of the trouble in a certain highly-placed 
 military official. A substantial douceur having been 
 provided, all difficulties vanished, and the ambulance 
 was allowed to proceed. 
 
 I was told again of a former chief of police who 
 had been dismissed and imprisoned for peculation 
 some years ago but was sent out by the Red Cross 
 Society with the sum of 60,000 to be expended in the 
 Far East. The whole sum disappeared none of it 
 on the objects for which it was intended and im- 
 pudent bribery had gained such a foothold in official 
 circles that the ex-chief of police was recalled and 
 given another appointment at headquarters. The 
 evidence one picks up in war-time and at the seat of 
 war must without doubt be taken with a double 
 pinch of salt ; but the evidence on this point was too 
 general, too succinct, to have been far wrong. 
 
 In the forty-nine prefectures of Japan, including 
 Hokkaido and Formosa, local Red Cross sections are 
 instituted, partly by the officials of the local govern- 
 ments and partly by the functionaries of the society. 
 They are assisted by a council of influential citizens ; 
 their headquarters are often in the local government 
 offices ; and local committees, with the mayors 
 as their chiefs ex officiis, are formed in all cities and 
 country districts. Besides a few honorary members 
 of the imperial family, membership of the society is 
 either special, following on special service or the 
 donation of 20 and upwards, or ordinary, entailing 
 a donation of 2, los. or an annual subscription of 
 3 yen (or florins) for a period of ten years. In 
 
240 HEALTH AND EMPIRE 
 
 addition to these subscriptions, donations and legacies 
 are also made by private benefactors, and grants by 
 the imperial household. Of the income of the 
 society a part goes to the local sections in the pro- 
 portion, firstly, in Formosa and Hokkaido, of 54 
 per cent. ; secondly, in prefectures where there are 
 headquarters of army divisions or naval stations, 
 of 40 per cent. ; and, thirdly, in other prefectures, 
 f 35 P er cent. The remainder goes to the central 
 board. 
 
 The funds of the society amounted to over 8,000,000 
 yen, or 800,000 ; the annual subscriptions in the 
 year in question were 2,354,558 yen, or nearly 
 235,000. In the summer of 1904 the staff of the 
 society included 314 physicians, 129 dispensers, 
 2391 nurses, 717 male attendants, 150 stretcher- 
 bearers, 87 clerks and 5 administrators. As a 
 retaining-fee administrators, physicians and dis- 
 pensers received 6s. a month ; assistant dispensers 
 and the chief male attendants, 35. ; other male 
 attendants and stretcher-bearers, is. ; and nurses, 
 nothing. This lack of pay to the nurses is justified 
 by the fact that they have received a gratuitous 
 training, which enables them to find good employ- 
 ment. On being called up for active service, or for 
 manoeuvres and other instruction, or for assistance 
 in the case of public calamity, some " departure 
 money " and travelling expenses are paid to them, 
 and a salary so much better than that paid to 
 members of the army medical service as is justified 
 by the fact that they are summoned from civil life 
 to undertake their duties. 
 
241 
 
 A special feature of the preparation of this reserve 
 is the training of its members. The society con- 
 tracts with certain chosen medical students in the 
 imperial universities of Tokyo and Kyoto to pay the 
 expense of their education, on condition that, on 
 graduation, they become reserve-physicians of the 
 society. They are then attached to the central 
 hospital of the society in Tokyo, where the famous 
 Dr. Baron Hashimoto decides on their efficiency. 
 One or two of these young doctors are always study- 
 ing in Europe at the expense of the society, but 
 for the present it would be impossible to train their 
 whole staff, and certain physicians trained in private 
 medical schools are engaged on the reserve of the 
 society, and instructed in the special duties of military 
 work by appropriate courses of lectures. 
 
 The training of nurses is of greater interest, because 
 it strikes new ground, and has a wider social effect, 
 in opening to the women of Japan a calling which 
 had not previously been held in good repute. In 
 so essentially aristocratic a country, it required some 
 courage and much tact to overcome the stigma that 
 naturally attached to the work of the sick-nurse. 
 The step was taken by certain ladies of high degree, 
 who boldly faced the situation and designedly 
 inaugurated the new system, with the result that the 
 stigma had by 1904, at least in the main centres, 
 entirely died out. Candidates for the nursing staff 
 of the Red Cross Society, between the ages of seven- 
 teen and thirty, are admitted, after an examination 
 in elementary subjects, to a three years' training 
 at headquarters or under the local sections, either in 
 Q 
 
242 HEALTH AND EMPIRE 
 
 hospitals of the society or by a specially instituted 
 training board or in private hospitals. Uniforms 
 and outfit are lent to them, and a monthly allowance 
 made of from ten to fifteen shillings for pocket-money. 
 Emphasis is evidently laid on the scientific side of 
 their training, for the first year and a half is devoted 
 to theoretical instruction and only the last half of 
 their training to practice. After successfully passing 
 their final examination, they enter the reserve of 
 the society under vow. The best are selected to 
 undergo a further six months' training under Baron 
 Hashimoto at Tokyo, and, if they successfully pass 
 a further examination, they are nominated chief 
 nurses as vacancies may occur. During the period 
 of their vow the nurses are eagerly sought after in 
 hospitals and for private work. They may marry 
 if they like, but they remain at the call of the society ; 
 and now the society has created at headquarters a 
 " Board of External Service " for the nurses, practic- 
 ally a nursing institution, which receives all fees 
 and pays the nurses an annual wage. 
 
 The training of male attendants is an easier matter. 
 Perhaps it should be taken as a compliment to the 
 greater ability of the male mind that a training of 
 ten months is considered sufficient for the male 
 attendant ; his age is from twenty to thirty-four, and 
 his allowance double that of the nurses viz. sixteen 
 to thirty shillings a month. Of this training the first 
 five months are spent in theory, and the remaining 
 five in practice in hospitals of the imperial army. 
 The men are thus brought up in the atmosphere of 
 military organisation as the very breath of their 
 
JAPANESE RED CROSS 248 
 
 nostrils. The best are selected for a further two 
 months of study, with increased allowance. Un- 
 fortunately, they can find after graduation but 
 little private employment, and so they are given 
 frequent exercise at their duties in manoeuvres, 
 and, whenever possible, in cases of public calamity. 
 
 Stretcher-bearers form a fourth class for whom 
 training must be provided. They must be under 
 thirty-seven years of age, and, during three months' 
 training in the art of transporting the sick and 
 wounded, they are taught such useful sundries as the 
 improvisation of ropes and stretchers, their ingenuity 
 in this line being probably unequalled in any other 
 army in the world. During this training they 
 receive a monthly allowance of thirty shillings, with 
 uniform and outfit, and the best are given a month 
 of further training, which qualifies them for appoint- 
 ment as chief stretcher-bearers. They too can find 
 but little private employment as such and there is 
 some difficulty in recruiting them. 
 
 The vow of all nurses is for fifteen years ; that of 
 male attendants, ten years ; of stretcher-bearers, 
 seven years ; of physicians, dispensers, administra- 
 tors, clerks, chief attendants and chief stretcher- 
 bearers, five years. For nurses, dispensers, physi- 
 cians and administrators, the retiring age is fifty-five ; 
 for all others, forty-five. 
 
 To understand the careful way in which the work 
 of the Red Cross Society is sandwiched in with that 
 of the army medical department, and the whole 
 embodied in the general military system, instead of 
 being a mere appendage, it is necessary briefly to 
 
244 HEALTH AND EMPIRE 
 
 describe the scheme on which the medical service 
 both in the army and in the society is organised. 
 After the Chinese War of 1894-1895 missions were 
 sent over to Europe to study the work of sister- 
 societies. In accordance with this mission, in con- 
 sultation with the military authorities, the first 
 regulation for relief service in time of war was rati- 
 fied by the minister of war in October, 1898, and put 
 into practice in the Boxer troubles in 1900, which 
 suggested certain modifications embodied in its newer 
 form in November, 1903. In a campaign the sphere 
 of military activity is divided into three zones 
 the base ; the lines of communication, or 'etape ; 
 and the front. At the front the sanitary corps 
 and the field-hospitals are administered under the 
 direction of the chief of the medical staff of the army, 
 or of the divisions composing it. Along the lines of 
 communication the transport of sick and wounded 
 and the maintenance of hospitals are carried out 
 under the chief of the medical staff of each line of 
 communication. The base is divided into so many 
 territorial divisions, each with its medical service 
 under a chief who administers the affairs of the base- 
 hospitals. Attached to imperial headquarters, which 
 may be situated at the base or on the lines of com- 
 munication, is the director-general of field sanitary 
 service, to whom the chiefs of the medical service 
 on each line of communication are directly re- 
 sponsible. 
 
 Such being the organisation of the army medical 
 service, that of the Red Cross Society follows it 
 closely. The reserve-hospital and rest-stations at 
 
JAPANESE RED CROSS 245 
 
 the base are under the direct control of the president 
 and the chiefs of local sections, who are in touch with 
 the commanders of the corresponding territorial 
 divisions. To imperial headquarters is attached the 
 general administrator of the whole society, whose 
 function it is to direct and control the service of all 
 the relief corps of the society sent out to the lines of 
 communication. These corps work only at the base 
 or on the lines of communication ; and their work 
 appears to be good ; but there appears to be one 
 slight flaw in the arrangements. The general ad- 
 ministrator of the society takes his orders only in 
 medical aifairs from the director-general of the field 
 sanitary service, in others from the inspector-general 
 of the lines of communication. He works similarly 
 through his administrators, one for each line of com- 
 munication, who in their turn take orders only in 
 medical affairs from the chiefs of the medical staff 
 of their lines of communication, but otherwise from 
 the inspectors, who are purely military officers. The 
 relief despatched by the society to the lines of com- 
 munication takes the form of relief corps, under a 
 manager, who again takes his orders in purely medical 
 affairs from the chief medical officer of the locality 
 or unit, but other orders from the military or naval 
 authorities, subject always to the instructions of the 
 administrator along his line of communication. As 
 a rule the manager of such a relief corps is not a 
 physician. The society's service, therefore, is work- 
 ing under two separate authorities, medical and 
 military, as is the army medical service itself ; in 
 professional duties only are its agents under the 
 
246 HEALTH AND EMPIRE 
 
 control of the medical officers of the military service. 
 Such a system must entail much extra trouble and 
 delay ; a military service should, subject to its 
 general subordination to military command, be able 
 to manage all its own affairs by itself. 
 
 The relief corps of the society consists of separate 
 detachments, which are found far more useful to the 
 army than separate hospitals. The relief detach- 
 ments have as their standard an organisation reckoned 
 to treat 100 patients, with 2 physicians, a dispenser, 
 a clerk, and 22 nurses or attendants. Of 112 such 
 detachments for the army and 4 for the navy in 1904, 
 94 were formed with nurses, and they alone were 
 used at the base ; 18 were formed with male attend- 
 ants, and they were more frequently employed along 
 the lines of communication. Three relief corps are 
 organised as transport columns, calculated for the 
 transport of 30 specially serious patients, with a 
 manager, a physician, a clerk, 5 attendants and 123 
 stretcher-bearers. Two relief corps are organised in 
 the equipment of two hospital-ships one for 200 and 
 the other for 100 patients in which corps, in time of 
 war, it is interesting to read that a mechanic, an 
 interpreter, a barber and a washerman are also in- 
 cluded. Another relief corps is organised as a supply 
 depdt for medical and sanitary material, for clothing 
 and bedding, and for stationery, to work on the lines 
 of communication. In time of peace only one such 
 d6p6t is kept ready, but hi war others may be formed 
 at once. Finally, the Red Cross Society organises 
 in Japan rest-stations at ports of disembarkation, 
 and at railway stations through which patients travel, 
 
JAPANESE RED CROSS 247 
 
 the regulations and the staffing for such rest-stations 
 being left entirely to the local sections of the pre- 
 fectures in which they are situated. 
 IfJEt will thus be seen that the organisation of the 
 Red Cross Society is complete and independent. The 
 material needed by the relief corps serving at the base 
 is supplied directly by the headquarters of the 
 society ; that required by relief corps on the lines of 
 communication by the supply dep6t in the field. 
 Rapid mobilisation is ensured by two detailed reports 
 of the preparation made for the purpose for the coming 
 year, presented by the president of the society to the 
 ministers of war and navy before the end of September 
 in each year. On receiving these reports the ministers 
 assign to such relief corps as are likely to be needed 
 fixed services in the naval and military systems in 
 case of war. The whole plan of mobilisation, with 
 the necessary orders already as far as possible 
 printed is stored away at headquarters and with the 
 local sections, so that only the date, names and time 
 and place of formation have to be filled in before 
 issue. The distances of the abodes of different 
 members of the corps are kept in a list, so that it may 
 be known exactly in how many hours orders can 
 reach them. 
 
 Baroness Sannomiya's kind invitation took me on 
 ist July 1904 to the Red Cross Society's depdt and 
 store, in a different part of Tokyo from the hospital. 
 The ladies of the Red Cross had formed a volunteer 
 aid society, which, with all other voluntary bodies 
 concerned with the bodily and monetary relief of 
 soldiers and sailors and their families, was co-ordinated 
 
248 HEALTH AND EMPIRE 
 
 under the Red Cross Society ; and of this a small 
 donation had made me a life-member, with medal, 
 ribbon, button and certificate in Japanese characters, 
 signed by the Emperor, complete. The Baroness 
 Sannomiya, an English lady, and wife of the Master of 
 the Imperial Household, was the heart and soul of the 
 ladies' organisation. She herself on the occasion 
 of my visit showed me all the details of the work, 
 introducing me to several of the workers. An 
 elderly, white-bearded doctor, retired from the 
 Japanese Army Medical Service, was giving his 
 weekly lecture on bandaging and first-aid on a 
 dummy to a large roomful of little native women in 
 sandals, Japanese costume, and elaborate coiffures, 
 associates of the Red Cross Society; "such an ex- 
 cellent thing," as the baroness said, " for their homes, 
 if not of very great importance to the army." The 
 nobility appear on these occasions for evidently 
 their presence is a considerable attraction to the 
 people as, for instance, two delicate little ladies 
 of royal blood, besides the Princess Nashimoto, whose 
 husband was on his way to the front and who talked 
 of photography in eager French. A fourth lady, 
 who sat with them in an alcove of the room, and with 
 whom I made a vain endeavour to shake hands as 
 with the rest, must have been a lady-in-waiting ; 
 and bustling about in the crowd were Baroness 
 Nobeshima, mother of Princess Nashimoto and wife 
 of the only daimyo who takes any prominent part 
 in public affairs, and Marchioness Oyama, who has 
 lived for some time in America, and spoke charm- 
 ingly in fluent English of her many Anglo-Saxon 
 
JAPANESE RED CROSS 249 
 
 friends. In a corner were two or three large cards, 
 on which were mounted about fifty models, beauti- 
 fully made, of every kind of improvised stretcher and 
 carrying apparatus for sick and wounded. To my 
 intense delight, the Red Cross Society, at the instance 
 of the baroness, subsequently made and sent me as a 
 present a replica of these beautiful models, which are 
 now exhibited in the museum of our Royal Army 
 Medical College at Millbank. 
 
 Two kindly Japanese gentlemen showed me round 
 the vast stores, in which, without being able to under- 
 stand their comments, I noticed several useful im- 
 provements on our South African equipment light 
 and handy trunks instead of our clumsy and heavy 
 hide-covered panniers ; scales on the Danish lever 
 principle ; measures and cups of hard paper ; paper 
 for use as mops in surgical dressings ; powders al- 
 ready made up in little paper packets ; stomach and 
 rectal rubber tubes ; and a really useful and intelligent 
 selection of surgical instruments. They had good 
 cases of carpenters' tools, presumably for the purpose 
 of making splints and stretchers. Their warm quilted 
 clothing looked at least extremely comfortable if it 
 wears well and does not become infested with animal 
 life, it would be of use for our own or our Indian 
 army in cold climates. In only two points their 
 lacquered aluminium water-bottles and their supply 
 of " gooched " wood for splints should I say that 
 we in South Africa had the advantage. 
 
 I have treated at some length of the constitution 
 and work of the Japanese Red Cross Society, for 
 some effort is now being made in an interval of peace 
 
250 HEALTH AND EMPIRE 
 
 to organise our own scattered and conflicting instru- 
 ments for voluntary relief in time of war into an 
 effective machine, on a recognised basis, with recog- 
 nised duties and responsibilities, professedly after the 
 foreign model. It is unnecessary to dilate upon 
 the waste of money and material that resulted from 
 the lack of such organisation in South Africa ; it is 
 unnecessary to labour the jealousies and rivalries to 
 which it gave rise and the diminution of authority, 
 of efficiency and of subsequent credit which it im- 
 posed on the Royal Army Medical Corps. What is 
 necessary is to drum three ideas into our countrymen's 
 heads : firstly, that whatever may be our belief as 
 to the moral or even commercial value and as to the 
 feasibility of abolishing war, no such beliefs in the 
 positive are shared by continental nations, from which 
 it follows that war may come on us even this year, as 
 on France in 1870, as a thief in the night, and against 
 that calamity we should prepare ourselves, insure 
 ourselves, forthwith ; secondly, that preparation for 
 war makes a most attractive and practical framework 
 for the citizen's duties in times of peace ; thirdly, 
 that the movement should be national, not sectional, 
 the burden spread over the whole populace and 
 not confined to those who realise their duties most 
 keenly. 
 
 To this end in 1898 a " Central British Red Cross 
 Council " was formed of representatives from " The 
 National Society for Aid to the Sick and Wounded in 
 War," the St. John's and St. Andrew's Ambulance 
 Associations and the Army Nursing Service Reserve, 
 with three representatives of the War Office and one 
 
JAPANESE RED CROSS 251 
 
 of the Admiralty. To this end, after the South African 
 War, in which the National Aid Society spent 162,000, 
 these bodies were fused in 1905 into a single British 
 Red Cross Society, with King Edward as patron; 
 Queen Alexandra, president ; Lord Rothschild, 
 chairman of council, and Sir Frederick Treves, chair- 
 man of the executive. To the same end, in co-opera- 
 tion with the British Red Cross Society, the War 
 Office in 1909 initiated a scheme for the organisation 
 of voluntary aid detachments under the county 
 associations responsible for the territorial force 
 throughout Great Britain. Of these voluntary aid 
 detachments there were 415 at the end of January 
 last, with a personnel of nearly 4000 men and over 
 8000 women, or 12,500 in all. 
 
 The peace value of this organisation is likely to 
 be considerable, owing to the requirement by the 
 War Office that candidates for the women's detach- 
 ments should be either trained nurses or cooks, or 
 should be in possession of certificates for first-aid and 
 in home-nursing. For this purpose lectures are being 
 given and classes held in the basis of a syllabus alike to 
 that of the London County Council. Combined with 
 the boys' and girls' scout movement this should serve 
 to raise very materially the knowledge of the rules 
 of health and to stimulate public opinion as to their 
 value. It is on this general knowledge and apprecia- 
 tion of the rules of health that the health of the nation 
 must ultimately depend. 
 
 But the Red Cross Society has as its primary object 
 the furnishing of aid both to the navy and army, both 
 to the territorial and to the expeditionary force, in 
 
252 HEALTH AND EMPIRE 
 
 time of war and for this object to promote the 
 organisation of Red Cross work throughout the Empire 
 as well as at home. In case of war it would propose, 
 following the precedent set in South Africa, to equip 
 hospital ships and trains, provide auxiliary hospitals 
 and convalescent homes, make supplementary arrange- 
 ments for transport of sick and wounded, establish 
 food-dep6ts along lines of communication and supply 
 certain articles of clothing and comforts over and 
 above the official requirements. 
 
 The Red Cross Society might also perform a most 
 useful function in supplying additional personnel for 
 the medical services of the army. Machinery should 
 be established through someone of influence at each 
 medical school, for the selection, when required, of 
 suitable young surgeons, on whom, however, any 
 retaining fee is absolutely thrown away. A still 
 greater difficulty in the South African War was that 
 of supplying the need of male nurses ; and for this 
 purpose arrangements should be made, in connection 
 with the work of the voluntary aid detachments, for 
 civilian hospitals to undertake the training of male 
 nurses, of whom there is always need for a few in the 
 casualty ward and strong-room. 
 
 Owing to the better organisation of our army 
 medical department, especially since Mr. Brodrick's 
 reforms, the work required of a British Red Cross 
 Society is less essential to the welfare of the navy and 
 army than that required of the Red Cross Society of 
 Japan. But it must be remembered that the standard 
 of comfort desired, if not demanded, for the sick and 
 wounded in the field differs widely in the two cases ; 
 
JAPANESE RED CROSS 258 
 
 the standard of comfort to which the soldiers and 
 sailors of the two island powers are accustomed in 
 times of peace is very different. Moreover it is 
 essential to give scope for the activities of those who, 
 full of patriotic feeling and of sympathy for the com- 
 batants, are themselves debarred from fighting. The 
 actual value of the bandages rolled in the Red Cross 
 d6pot at Tokyo may have been small ; the moral 
 effect of those classes was very large. The extra- 
 ordinary influence which the Emperor and Empress 
 of Japan and the leading Japanese nobility have 
 brought to bear with effect on the formation and 
 triumphant working of their Red Cross Society gives 
 warrant for an earnest hope that their Majesties, 
 King George and Queen Mary, may similarly succeed 
 in consolidating a work of such great beneficence to 
 the individual soldier, of such great importance to 
 the nation, under a Royal Red Cross Society extend- 
 ing to every corner of the BritisfrEmpire. 
 
CHAPTER XIII 
 
 THE AFTERMATH OF THE RUSSO-JAPANESE WAR 
 
 The International Rank oj japan. For those who 
 read with understanding, or have been privileged 
 to see something of latter-day Japan, it is difficult 
 to write without an undue use of the superlative. 
 There can be no doubt as to the completeness of her 
 victory in the recent war, both on land and sea ; 
 none as to the thoroughness of her official preparation 
 for the struggle, or the sympathy with official action 
 that saturated every class of her people ; none as to 
 the simplicity and natural power of her domestic 
 life ; no doubt, in short, as to her first-rate equip- 
 ment for competition with other great nations of the 
 world, or her paramount naval and military supre- 
 macy, at least amongst all powers east of Suez. We 
 Englishmen and our American cousins are above all 
 qualified to appreciate the significance of her unique 
 and rapid rise to this position. Our own defeat 
 of Spain and Holland in the sixteenth century and 
 subsequent mastery of the waterways of the world ; 
 our own conquest or colonisation of North America, 
 of India, of Australia ; our permeation of Africa ; 
 our European victories a century ago ; the spread 
 of our flag and of our trade in ports of all the seven 
 seas and the lands behind them, enable us to imagine 
 
 254 
 
THE AFTERMATH 255 
 
 the significance of the recent rise to power in Asia of 
 a nation with a history, strategic position, resources, 
 spirit and temper in many ways like our own. In 
 relation to the oceanic world, the United States 
 hold the keys of America; Great Britain, for the 
 present, of Europe, Africa and Australia. Japan seems 
 destined to hold the keys of the Asiatic continent. 
 
 This stipulates, without a doubt, a certain faith in 
 the commercial abilities of the Japanese people, with 
 an expansive power to stimulate the growth of a large 
 merchant-fleet and necessitate the constant efficiency 
 and the increase of her navy and army. If so we 
 read the facts, we must grant to Japan the first 
 position on the waters between at least the Straits 
 of Malacca and the American coast, north of the 
 Panama Canal, and the Indo-Australian ocean-road. 
 
 The Aims of Japan. If we rightly understand 
 the motives and ambitions of our eastern ally, it 
 would seem certain that her object has been no mere 
 military triumph, but a stable condition of affairs in 
 which she may have full opportunity to develop her 
 commercial activities. She has thrown off the corset 
 to give her body full play. In establishing, therefore, 
 her new position in the hegemony of the world, she 
 would above all seek to establish international peace 
 on the sea and secure equal rights and opportunities 
 for her trade with other nations that may in trade 
 be her rivals. In the recent war she has striven not 
 merely to defeat Russia, but to establish her in- 
 dependent power and prestige in the sight of all 
 nations. It is not least for that reason that she 
 
256 HEALTH AND EMPIRE 
 
 prided herself on her financial achievements, that she 
 conformed strictly to the properties of western 
 diplomatic usage, that she refused all offers of help 
 from outside, even from myself and others in the care 
 of her sick and wounded, and showed a noteworthy 
 advance in her humanity since her war with China ; 
 and that she steadfastly preserved the integrity of 
 the ring round herself and her late antagonist. It was 
 not least on these grounds, we believe, amongst 
 others, that she was content to forego many of her 
 demands that appeared legitimate and reasonable in 
 the final negotiations at Portsmouth, since the ulti- 
 mate terms assured in some degree the future peace 
 of the maritime world, as well as freedom for Japanese 
 expansion on the Asiatic continent. It is these facts 
 that suggest a practical policy for adoption in the 
 interests of universal peace by five chief nations of 
 the world. 
 
 The suggestion was made while Russia was still 
 at war with Japan, while Great Britain, in addition 
 to her traditional distrust of Russian policy in near 
 and middle east, was fired by the admiration of her 
 valiant ally and was smarting under the provocation 
 of Rojhdestvensky's exploit in the North Sea. The 
 suggestion, recorded in ink and rejected by two 
 monthly reviews as premature, in 1905, is already in 
 1911 to some extent an established fact and out of 
 date. Its prospect is therefore encouraging. 
 
 The Five-Power League. This proposal is inspired 
 by the success that has already attended King 
 Edward VI I. 's most remarkable diplomatic achieve- 
 
THE AFTERMATH 257 
 
 ment, the cordial agreement between Great Britain 
 and France. For half-a-century these two nations 
 had been at loggerheads. In one diplomatic 
 movement these difficulties were frankly recognised, 
 considered and swept aside ; each nation acknow- 
 ledged the legitimate aims of the other, and by a 
 scheme of give-and-take they now appear before 
 the world as the staunchest of friends. As with 
 France, so with Russia. The Crimea, India, Persia 
 are no longer a source of contention and distrust. 
 The mid-east has to count now on our co-operation, 
 not our rivalry ; and in her struggles for peaceful 
 development at home Russia draws nearer to Great 
 Britain every day. 
 
 There is then a certain basis of fact the alliance 
 between Russia and France, the agreement between 
 France and ourselves, the no less remarkable alli- 
 ance between ourselves and Japan, and the friendly 
 sympathy of our kinsmen in the United States. 
 There is already a definite knot connecting every 
 pair of nations here named, which thus constitute 
 a girdle of power, beginning with Japan, passing 
 across North America and the Atlantic to ourselves 
 and France, ending in European and Asiatic Russia. 
 Since agreement has now been confirmed between 
 the two ends of this chain, whose extremes met in the 
 recent campaign, the circle is diplomatically com- 
 plete and the world girdled by a zone of powers, 
 content with the present disposition of the earth's 
 surface and therefore intent on peace. This war we 
 look on as the necessary preparation for such an 
 arrangement. Before the war Russia did not realise 
 
258 HEALTH AND EMPIRE 
 
 the strength and the future of Japan ; it is not 
 certain that Japan or the other great powers of the 
 world yet fully realise the strength, still less the 
 probable and legitimate future, of Russia. It was 
 impossible, without some such understanding, for 
 Russia and Japan to come to terms. That being 
 now effected, it will now also be possible for the five 
 nations in question to agree upon a general policy. 
 
 The Effect of Improved Communications. The full 
 significance of last century's achievements, through 
 steam and electricity, penny postage, national 
 education and the Press, has not yet been fully 
 realised. Is it not a logical result of these inven- 
 tions that no national or international act be- 
 tween civilised powers can now be done in secret ? 
 Did not these very agencies avert the most serious 
 issue in the case of the Dogger Bank incident, when 
 their absence might have precipitated a second 
 battle of Navarino ? Differences and mishaps such 
 as this may then surely and invariably henceforth 
 be settled between peaceable nations by agreement ; 
 and the peaceable attitude may be no less surely 
 prepared by a deliberate and comprehensive survey 
 between all nations of their respective strength and 
 interests and by a series of ententes, at first 
 between nations already friendly and then between 
 those reputedly hostile. The loss is in each case 
 small, the loss of any advantage that might have been 
 obtained by bluff or other war-endangering device. 
 The advantage would seem in proportion great, the 
 businesslike advantage of national security in the 
 
THE AFTERMATH 259 
 
 pursuit of acknowledged aims, coupled with the 
 active help of the co-operating nations in their 
 pursuit. The loss appears ever less as the influence 
 of last century's scientific progress becomes more 
 clearly realised. This is the true method of pre- 
 venting war, apart from the inculcation of the idea 
 that peace is desirable. It is operating now and has 
 already prevented war ; and it can always claim a 
 precedent in that duelling has ceased in England for 
 nearly a century. 
 
 Arbitration is quite another thing. Arbitration 
 between two powers who have come to blows without 
 a previous understanding and without the desire for 
 peace is of little value ; and we may be grateful to 
 the German Chancellor for reminding us that might 
 is still right in the eyes of many and that arbitration 
 in those eyes is valueless. Grant, however, the 
 understanding and the desire for peace, as in the case 
 of the United States and ourselves ; and arbitration 
 will become a useful and natural method of settling 
 disputed points. Arbitration is diplomacy in public ; 
 but it cannot enforce its conclusions on nations who 
 may deny their justice and have power to resist them. 
 
 The advantages of mutual understanding are adver- 
 tised by each successive international agreement, 
 great or small. In a game of bridge, beginners 
 play every hand through to a finish ; experts 
 throw their hands on the table, three, four or more 
 tricks before the end. Politics is but a game of 
 cards for heavy stakes. It is generally a game of 
 bridge, not of whist, with at least one dummy hand 
 exposed throughout. We have so many tricks, let 
 
260 HEALTH AND EMPIRE 
 
 us say ; for we have one or two leading cards in our 
 hand. You take the rest. Let us count the score. 
 
 The United States. If then the understandings 
 and agreements between France, Russia, Japan and 
 ourselves be likely to prevent international war, so 
 much the more probable and effective will be the 
 inclusion of the United States in this group. The 
 proposals for fiscal reciprocity between the States 
 and Canada, their common interests and growing 
 communications with Australia, New Zealand and 
 the United Kingdom, are drawing the States closer to 
 each dominion of the British Empire ; while their 
 relations with Japan on the one side and France on 
 the other are free and friendly. If only for selfish 
 reasons, they must, like ourselves, desire the world's 
 peace. They would not, therefore, enter into any 
 such powerful combination, if such action were viewed 
 with hostility, for instance, 'by the triple alliance. 
 For that reason the agreement proposed must de- 
 velop slowly and naturally ; understanding with 
 other powers must develop concurrently ; but public 
 attention must for practical reasons be focussed on 
 the agreement of the five powers as the first aim. 
 
 The Triple Alliance. It is an age of large con- 
 cerns ; and this proposal aims at concentrating the 
 most active powers of the world into two definite 
 groups, the five-power chain to match the triple 
 alliance. But the friendship between ourselves and 
 Italy should act like the understanding between 
 ourselves and France during the Russo-Japanese 
 
THE AFTERMATH 261 
 
 War, when feeling ruled high under much pro- 
 vocation between this country and Russia. Italy 
 might be the means of gradually accustoming the 
 chain and the triple alliance to understand each 
 other's power and aims. Surely a comprehensive 
 understanding is more likelv to be effected by first 
 
 \j */ */ 
 
 grouping the powers on two sides than by a series 
 of partial understandings between each pair of the 
 eight powers concerned. This possibility is made 
 more likely by the increasing co-operation between 
 Germany and ourselves in the near and far east, by 
 the increasing facilities for the expression of inter- 
 national opinion, by the more widespread apprecia- 
 tion of the burden of armaments, and of the hindrance 
 it imposes on commerce and therefore on national 
 prosperity. In a general understanding between the 
 chain and the triple alliance lies the best, if not the 
 only, hope for the limitation of armaments and the 
 cessation of war. But the understanding must come 
 first. 
 
 The Danger of Further Understandings. But the 
 danger of this policy must be freely stated for it to 
 be avoided. In seeking friendship with the triple 
 alliance we shall be endangering our friendship with 
 France unless it is clear that the one is dependent on 
 the other. No major diplomatic agreement there- 
 fore is desirable between individual nations on either 
 side, except by the consent of their partners. Such 
 no doubt is the policy of our diplomatic service at 
 the present day. It needs to be impressed also on 
 public opinion. 
 
262 HEALTH AND EMPIRE 
 
 So in the same way closer direct relations 
 between our dominions and other, even friendly, 
 powers must tend to loosen the bonds of Empire, 
 and should only be entertained concurrently with 
 the progressive consolidation of the Empire. 
 
 German Expansion. And meanwhile we must go 
 armed to the teeth. Nothing strikes the British 
 traveller more, if he is concerned in world politics, 
 than the astonishing growth of German influence in 
 all spheres of modern life and in all parts of the globe. 
 
 Saturated at home with his original articles and 
 text-books, newspapers and blue-books, in every case 
 comparing British conditions more especially with 
 German and showing an extraordinary development 
 to the advantage and credit of Germany during the 
 last thirty years, the Briton sets out on a holiday to 
 Switzerland or the Riviera, and finds the German 
 competing with him again in the wealth and leisure 
 hitherto considered the monopoly of the Englishman 
 and the American. He travels to South America or 
 the States, and the German is there also ; to each 
 port in the circuit of Africa, and the German is 
 established in every one ; to the most distant lands 
 in the Pacific, and German commerce is growing. 
 In Singapore the naval and commercial cross- 
 roads from Europe and India to Australasia and 
 the far east the business men seem to be mostly 
 German or Dutch, and the finest building of the sort 
 is the German club-house. Both there and in Hong- 
 Kong the proportion of German shipping had, at 
 the time of my visit, been steadily increasing, and 
 
THE AFTERMATH 263 
 
 the German leasehold of Kiao Chau was being 
 methodically developed as a centre of German com- 
 merce and power in celestial waters. 
 
 This is no occasion for jealousy ; the British 
 character is not selfish, and indirectly British com- 
 merce takes its share of any commercial development, 
 except that behind closed ports. But would a 
 German Sir Walter Raleigh rest content in the present 
 day ? There is every need of anxiety, for we have 
 everything, Germany little, to lose by a war ; we oc- 
 cupy with a scanty population many of the countries 
 best suited for development ; Germany, longing for 
 similar outposts, is bursting with commercial and 
 imperial energy. She will soon have usurped the 
 jingo song : 
 
 " We've got the men, we've got the ships, 
 We've got the money too," 
 
 and when the favourable opportunity occurs and 
 the military party in Prussia see their way, it will 
 then go hard with our empire in the Pacific, unless 
 in every vulnerable quarter and Australasia is the 
 most vulnerable, unless in constant proportion to 
 rival powers, we go armed to the teeth. 
 
 The Function of Navies. A self-contained 
 country with peaceful intentions requires little of a 
 navy for the protection of its coasts and its com- 
 merce. But extension of power and of commerce 
 requires naval strength ; and a scattered empire 
 requires naval strength. A navy is above all re- 
 quired for the protection of commerce, and must bear 
 a definite proportion to the amount and vulnerability 
 
264 HEALTH AND EMPIRE 
 
 of trade it has to protect ; that is the justification for 
 expanding the British navy. But the navy gives 
 power in every sea, and no country with growing 
 energies can submit to be permanently subject in 
 every sea to the dominance of its rival, on whose 
 motives and justice it cannot feel sure. That is the 
 reason for the miracle of the German navy. Neither 
 country can object to the naval policy of the other ; 
 but interests are bound to clash, and even the 
 most peaceable intentions for settlement are in fact 
 subject to the final arbitrament of war, either latent 
 or realised. The sooner we rivet up the five-power 
 chain the sooner will it be possible to come to a 
 general understanding with the triple alliance, to 
 reduce the probability of great wars and to set free 
 money now spent on the arts of war for the more 
 productive arts of peace. 
 
 China. We shall be none too soon ; for the 
 nations of the west are in face of a greater danger than 
 war between themselves, a greater danger than war 
 itself. China, the most peaceful of nations when 
 undisturbed, the least ambitious because the most 
 assured of its pre-eminence, has against its will been 
 enlightened and aroused by the forceful intrusion of 
 the European powers. Actuated for the most part 
 by the internal impulse of expansion, to some extent 
 by a partial benevolence towards the Chinese, they 
 have insisted on a policy of peaceful penetration, 
 grounded on force. Portugal and England, Russia 
 and France, Germany and the United States have all 
 assisted in this policy in China, a policy, indeed, 
 
THE AFTERMATH 265 
 
 applied not specifically to China, but generally to 
 the whole non-Europeanised world. Regardless of 
 other civilisations, ignorant of other codes of morality 
 and justice, of other standards of happiness and 
 prosperity, Europe has insisted on disturbing the 
 social equilibrium of every race unable to withstand 
 interference, in order to do away with injustice, to do 
 away with the gamble in life, to force their treasures 
 and their labour into the world's market and to force 
 on them the consequent discontent which leads to 
 luxury, revolution and the misery inseparable from 
 international competition. Japan was the first to 
 take up the challenge. Fifty years ago the Japanese 
 were the toy things of Europe ; to-day they are a 
 power of the first class. Ten years ago the Boxer 
 outbreak showed the strength and weakness of China 
 to the world and to herself ; even five years ago her 
 professed intention to abolish the opium habit was 
 regarded as a trick ; to-day it is on the way to 
 accomplishment. She is building railways ; she is 
 building up a constitution ; she is learning European 
 inventions and sciences ; she too is entering the 
 " comity " of nations. When China too begins to 
 preserve life and to swell with the desire for expan- 
 sion, in which direction will she expand ? Through 
 inhospitable Thibet into India ? Through Turkestan 
 into Russia ? Or across the seas to the vacant lands 
 of Australia ? " Eventually," said Li Hung-Chang 
 once to one of my fellow-travellers, " you will all 
 have to go; unless you stay behind as coolies." 
 And Sir Robert Hart has told us that a Viceroy 
 exclaimed : " Fools, you Europeans, trying to wake 
 
266 HEALTH AND EMPIRE 
 
 us up to military power. We don't want it ; but it 
 will come now, and you will be sorry for it." 
 
 The Real Yellow Peril. But there is no need 
 to presume she will have to use the force that will 
 inevitably be hers, with her one-fifth of the world's 
 population, and her national characteristics of 
 wisdom, ruthlessness and endurance. She too is 
 already adopting a reciprocal policy of peaceful 
 penetration. In Singapore all the shops appeared 
 to be Chinese ; in Perak the big villas belonged to 
 the prosperous Chinese ; the Malay States were de- 
 pending for revenue and for development on tin, and 
 the tin mines on voluntary importations of Chinese ; 
 Kuala Lumpur, their capital, in a population of 
 32,000 at the last census in 1901 numbered no less 
 than 23,000 Chinese. The boat which took me from 
 Saigon to Hong-Kong under an English captain was 
 one of the old blue-funnels of the Holt Line, which 
 had sold its Borneo steamers to the Nord-Deutscher 
 Lloyd and this boat and another to a Chinaman, 
 once an office-clerk in Hong-Kong. In every country 
 round the Pacific the Chinese are known to be the 
 most honest and the best workers, either as labourers, 
 clerks or merchants. Force China into the world's 
 markets and she will beat every one of her rivals to 
 whatever extent she may please. She is so being 
 forced ; her appetite is being whetted ; our European 
 imports are rammed down her throat and Chinese 
 exports must in return be exploited abroad. As 
 yet the competition is little felt, felt mostly by those 
 firms whose secrets China has, as yet indifferently, 
 
THE AFTERMATH 267 
 
 learned, and whose services are now superseded in 
 China's home markets. And when Chinese manu- 
 facturers enter foreign markets, they must at first be 
 handicapped by distance and by experience. But 
 that will pass and then the yellow peril will be 
 realised. Personal industry, intelligence, numerical 
 strength and an incredibly low wage combine to 
 make China a commercial power in the future with 
 which there would seem to be no possibility of 
 competing. A rising physician, a young Scot, once 
 told me his ideal laboratory would be worked by 
 Chinese, supervised by Germans and directed by 
 himself. 
 
 The Birth-rate, The numerical strength of the 
 Asiatic powers is no small factor in the situation. 
 For the last thirty or forty years the birth-rate of all 
 white nations, with the exception of Russia, has been 
 steadily declining ; that of Japan has steadily risen ; 
 those of China and India can only be surmised. The 
 white nations have learnt how to save, but also how 
 to prevent life ; Asia has learnt neither. We are 
 teaching the Asiatics how to prevent or minimise 
 war, famine and pestilence, to check infanticide, to 
 strengthen and prolong life. Under such conditions 
 the natural increase of the coloured races will be 
 overwhelming. Are we to wish that they too will 
 lose the natural desire for children and learn how to 
 check the birth-rate ? If not since Japan at least 
 is forewarned and forearmed, and China will not fail 
 to profit by the experience and weakness of the white 
 nations we have to face in the future an expanding 
 
268 HEALTH AND EMPIRE 
 
 force, which will intensify beyond measure the force 
 of the yellow peril. 
 
 Protection by Exclusion of Chinese. How is this 
 real Chinese peril to be met ? It is already met 
 in one respect by the most obvious method of pro- 
 tection, the importation of Chinese labour being 
 forbidden, or taxed out of serious existence, in most 
 or all the white men's ports south and east of the 
 Pacific. If China were to set up factories of her 
 own in the white man's land, even free trade would 
 hide her head, or would have no more head to hide. 
 Great as are the benefits of free competition to the 
 consumer, their price is too high if it is to lower the 
 standard of living in white communities to that in 
 China. And yet this would be the logical outcome 
 of theoretical free trade carried into universal 
 practice. Chinese labour working under European 
 direction on equal terms would in time be able to 
 undersell the produce of European labour ; and it is 
 for that reason that white labour, rather than white 
 capital, is unanimous in excluding Chinese workmen 
 from the shores of the Pacific, on which the white 
 men are themselves developing industries. 
 
 Effect on White Labour of Chinese Competition. 
 But protection of white labour cannot stop there. 
 Asiatic labour lives more cheaply, will be content 
 with lower wages, at home than in a white man's 
 land ; and as merchants in Asia, whether white or 
 Asiatic, find it worth their while, so will they be able 
 to develop industries based on Asiatic labour ; they 
 
THE AFTERMATH 269 
 
 would be handicapped after a time only by the cost 
 of freight, subject to the supply of raw material, of 
 which there is in China an ample supply of nearly 
 every kind awaiting exploitation. What is to pre- 
 vent Chinese rails, now making their debut on the 
 Chinese railways, from undercutting European rails 
 also abroad ? China is abolishing the opium habit, 
 reforming her government, her army, her currency ; 
 and as a precedent Japanese products are already 
 competing with European in European markets. 
 At first western capital may face the competition 
 and be content with smaller earnings ; but capital 
 is fluid and soon finds its way to the source of high 
 dividends even to the Far East, if needs be, to 
 support our successful rivals. Free competition 
 must in time focus itself on labour and the present 
 rivalry in armaments be replaced by rivalry in reduc- 
 tion of the standard of living. 
 
 The New Bonds of Empire. The rapid rise of 
 Japanese military power may then have its counter- 
 part in commerce, in both respects to be followed by 
 the slow but terribly sure and momentous progress 
 of China. If this be eventually true of Asiatic 
 labour, it must be true between all nations competing 
 at the present day. As surely as duelling has died 
 out or is dying out and the influences noted early in 
 this chapter are making for peace, so surely is inter- 
 national rivalry becoming focussed on industry. 
 Nay, more ; the lines of Empire are being rearranged 
 according to the channels of communication, in sub- 
 stitution for those of physical defence, and the navy 
 
270 HEALTH AND EMPIRE 
 
 and army are required only for the protection of 
 those channels, those bonds, which are becoming the 
 real meshwork of Empire. Consanguinity is losing 
 its force : firstly through migration, intermarriage 
 and free communications ; secondly through the 
 materialisation of ideal, resulting from modern com- 
 petition. The emigrant to Australia is at first, no 
 doubt, in close touch and sympathy with home ; 
 but he has a hard struggle to live, and if that struggle 
 brings him, through certain facilities, into constant 
 relations with a German house of business, it is with 
 Germany, not with England, that his interests will 
 lie ; correspondence, visits, education and even 
 intermarriage will in a few generations have shifted 
 the main sympathies of his family from England to 
 Germany. The same must be true of a whole trade 
 or state in proportion to the volume of its com- 
 munications ; and its communications will be mainly 
 those of commerce. 
 
 Free Competition and Social Reform. As sug- 
 gested in the future competition of Asiatic races, 
 so now in rivalry between the white, the burden of 
 free competition must eventually fall on labour and 
 its rising standard of living. But the health and 
 strength and output of a nation depend not least on 
 its standard of living, its food, its water-supply, its 
 sanitation, its facilities for recreation, its skilled 
 treatment in sickness. Health is the index of well- 
 being ; every movement for social progress involves 
 or depends upon a rising standard of living for the 
 masses. All these essentials of success must be cut 
 
THE AFTERMATH 271 
 
 down under free competition. Free competition, 
 absolute free trade, is in the end incompatible with 
 social reform. 
 
 The Neglected Measures of Defence. As against 
 Asiatic rivalry, so in all international rivalry, 
 protection cannot stop with mere bodily exclusion 
 of the extremists in cheap production. We must deny 
 to ourselves, as consumers, the benefits of sweated 
 labour, according to our criterion of sweating, 
 while retaining the benefits of free competition in 
 other respects. We must officially encourage manu- 
 factured imports from markets which work under 
 the same labour conditions as our own and dis- 
 courage in proportion all imports produced by labour 
 under worse conditions. To some extent and for 
 the present this may be done by improvement of 
 communications ; under shelter of naval defence and 
 of the postal service the British Government has 
 already made a timid step in this form of protection, 
 following the road-making example of imperial 
 Rome and the direct example of shipping subsidies 
 by Germany and Japan, amongst others. Indeed it 
 would be logical on sea as on land for the state to 
 establish means of transit without cost. But all 
 these measures are minor, palliative, temporary. 
 What strikes one in the Far East, in the development 
 of German influence, is their strategic use of every 
 means within their power. A German Consul and 
 a German trader with twenty years' experience in 
 Chinese waters summed up for me the advantages 
 of their trade in, firstly, their use of the metric 
 
272 HEALTH AND EMPIRE 
 
 system ; secondly, their adaptability to customers' 
 needs ; thirdly, their consular and commercial 
 services ; fourthly, their education ; fifthly, our 
 free advertisement of their goods as " Made in 
 Germany " ; but lastly and above all their Bis- 
 marckian policy, as they called it, of the scientific 
 use of a protective tariff. "Why not protect," they 
 said, " to the extent of enabling your producers to 
 produce what would otherwise be produced by their 
 rivals ? " 
 
 The Full Imperial Policy in the Interests of 
 Progress and Peace. It is this deliberate strengthen- 
 ing of every nerve and sinew, this use and develop- 
 ment of every sense and every nerve-cell, alike in 
 commerce and armament, that make the mailed fist 
 a formidable power throughout the world. It is 
 useless for us to tinker with one detail after another ; 
 to depend on natural development and on the sup- 
 remacy or monopoly which Great Britain has long 
 enjoyed in trade overseas. Reciprocity of one 
 dominion with the United States ; separate com- 
 mercial treaties with several countries ; the threads 
 of the shuttle being thrown to and fro between our 
 several dominions and foreign nations ; all tend in 
 themselves to undermine the community of the 
 British Empire. Now is the time to consolidate 
 the empire, as the United States were consolidated a 
 hundred and fifty years ago ; for the ocean is less of 
 a barrier now than were distances of land then. The 
 consolidation must be defensive and constitutional. 
 But these are only the outworks ; the essential bond is 
 
THE AFTERMATH 273 
 
 that of trade ; and, while protection of trade is 
 essential to maintain the national health and strength 
 as against nations of lower standard, so equally 
 must we aim at free trade within the Empire, where 
 a common standard for white labour is recognised 
 and coloured labour is under control. To this end 
 but only as part of the whole scheme and with all 
 the essential safeguards, limitations and adapta- 
 bilities a scientific scheme of import duties is 
 inevitably required, framed on the Bismarckian 
 model and giving, in the shape of imperial preference, 
 the power of the purse. 
 
 It is a real empire in being, not merely a nation 
 with distant connections, that should thus hope to 
 engage in the understanding with four other powers. 
 It is this five-power chain that may hope to secure 
 by further understanding with the triple alliance 
 the future military and commercial peace of the 
 world. It is this peace that alone can assure to the 
 world the utmost enjoyment of its fruits without any 
 impairment in the standard of living on which, 
 according to western belief, the health, strength and 
 happiness of nations must rest. 
 
CHAPTER XIV 
 
 RELIGION IN THE FAR EAST 
 {Read before the Christian Conference, London, 1905, and adapted) 
 
 IT was seven years ago, in June, 1904, when the Russo- 
 Japanese War was in its fifth month, that I found 
 myself with a fortnight in which to study conditions 
 affecting the public health at that toll-gate of British 
 and international commerce in the far east, Hong- 
 Kong. It was only eighty miles, seven hours in a 
 delightfully clean and spacious paddle-steamer, 
 owned and officered by Britishers, up the broad but 
 difficult Pearl River to Canton, the great commercial 
 terminus of South China, whence and whither most 
 of the foreign trade is conveyed in junks to or from 
 Hong-Kong. Here, more easily than in the other 
 main treaty ports of China, one is immediately in 
 the midst of real Chinese life. All European business 
 in South China centres in Hong-Kong ; and the 
 European community at Canton is therefore limited 
 to the Shameen a few hundred yards of river- 
 frontage with its gate guarded by a Chinese sentry. 
 For the night I was hospitably entertained by a 
 couple of young officials respectively of the British 
 Consulate and Chinese Customs, in the old Yamen 
 locked up in the heart of the native city. Locked up 
 for at six-thirty the gates of Canton are closed for 
 the night ; and we were probably the only Europeans 
 in the midst of two million Chinese. 
 
 274 
 
RELIGION IN THE FAR EAST 275 
 
 The experience of a night and a few hours of day- 
 light in this Chinese London gave a first introduction 
 to the life and problems of the Celestial Empire of 
 superlative importance as a foundation on which to 
 build out of subsequent glimpses and passing friend- 
 ships some conception of the Chinese character, of the 
 problems they have to face in their foreign intercourse, 
 and of the future towards which they are tending. 
 
 My hosts were eagerly learning the Chinese lan- 
 guage. Their instructor, a Chinese gentleman of 
 about forty, came to them one evening in great glee, 
 having received his commission in the imperial army. 
 What tests, they asked, had be been called on to 
 satisfy. He had been examined and found pro- 
 ficient, was his answer, in the Chinese classics, and 
 the use of the bow and arrow. " The use of the 
 bow ! " we exclaim, " and the Chinese classics ! 
 How absurd ! " But let us think again. Is it more 
 absurd than to examine candidates for Sandhurst 
 in Latin and Greek and to teach them the use of 
 the sword ? Sword and bow, classics of East and 
 West, are all alike obsolete. But the test still served 
 till recently in either hemisphere as a criterion of how 
 a candidate had fared in the competition with others 
 of his class, as a criterion of zeal and ability and of 
 the education befitting, it was supposed, a gentleman. 
 The moral to be drawn is the similarity of degree to 
 which civilisation has reached in China and in Europe, 
 with the definite development of the gentleman in 
 either hemisphere, and all the complexity and subtle 
 delicacy of feeling involved in the self-respect which 
 is at least as marked there as here. 
 
276 HEALTH AND EMPIRE 
 
 To one who had hitherto recognised but little the 
 reality of Chinese literature and culture, the trip in 
 a palankeen through the streets of Canton was of 
 itself a revelation. In this city of 2,000,000 every 
 street was under ten feet across and even so en- 
 croached on by stalls and bundles and goods on show, 
 and by the striking vertical signboards inscribed 
 with bold Chinese characters in black and gold. The 
 open shop-fronts showed vistas of splendid black- 
 wood furniture, silk-looms, native jewellery and 
 massive coffins a common feature sandwiched in 
 between shopfuls of Manchester cottons, German 
 clocks and American tobaccos ; but few European 
 and only one English advertisement did I see the 
 substance, in other words, but not the acknowledg- 
 ment of foreign influence. The busy crowds streamed 
 along on foot, mostly in single file ; and, above all 
 other impressions, it was their faces that made the 
 most indelible impression, active and thoughtful, 
 alive with power and individuality, although lacking 
 in softness or sympathy. So they bustled along, 
 taking little notice of us ; as we might bustle up 
 Threadneedle Street, taking little notice of an organ- 
 grinder and his monkey. An organ-grinder and his 
 monkey for whereas in India one feels a certain 
 recognised superiority over the masses, here it was 
 curious to feel that the passers-by felt as much 
 superior to the European as the European to them, 
 and that they looked on him not with respect, not 
 with pity, but with evident disdain. The pride of 
 the Chinese is not confined to the upper classes. The 
 masses of the nation have also an intense self-respect. 
 
RELIGION IN THE FAR EAST 277 
 
 For this there is good reason. Culture is widely 
 diffused ; indeed the Chinese consider it sadly 
 lacking in Canton and the other treaty ports. On 
 my way from Shanghai to Japan I travelled with an 
 American medical missionary on his way home with 
 wife and children on furlough, after twenty years 
 inland on the Yangtsze at Nankin. For real informa- 
 tion about a country, commend me to doctors and 
 missionaries. The former have an essential power 
 of observation and sense of proportion ; both have 
 a conspicuous love of what appears to them the 
 truth ; both lead a life, unique amongst the foreign 
 community, in close contact with all classes of the 
 population. A missionary to borrow a metaphor 
 from worldly life lays his " hand " down on the 
 table ; he conceals nothing, and such bias as he has 
 is perfectly honest and easily appreciated. This 
 doctor gave a most surprising account of the extent 
 to which China was becoming infiltrated with western 
 literature. He had himself found it worth his while 
 to translate Herbert Spencer's " First Principles," 
 and, as a set-off to it, Patrick Edward Dove's " Theory 
 of Human Progression," into Chinese : in a Chinese 
 monthly magazine of or concerning English literature 
 and history his translation was appearing in sections 
 of Green's " Short History " ; and European litera- 
 ture, as evidenced, for instance, by the sale of this 
 magazine, is read to an astounding extent by the 
 upper and middle classes, right into the interior of 
 China, constituting a veritable renaissance. Even 
 the remotest up-country villages have their literary 
 societies, whose members meet to read essays and 
 
278 HEALTH AND EMPIRE 
 
 poems of their own composition or to discuss, per- 
 haps, or recite their classics. 
 
 But personal impressions are perhaps the strongest 
 evidence ; and in a trip from Japan by Corea to 
 Tien-tsin my new conception of the Chinese char- 
 acter was confirmed by a few days' friendship with 
 an elderly officer of state, retiring from the Chinese 
 Consulate at Fusan to his home near Pekin. This 
 gentleman, coming on board in the well-known blue 
 silk dress, plaited pig-tail and stiff black cap, like 
 a biretta, adorned with the red button indicating 
 his rank, took his place quite naturally at table with 
 the first-class passengers and behaved himself with 
 such reserve and natural dignity as could not fail to 
 attract attention. He had been for four years in 
 the Embassy at Washington, and at our first con- 
 versation expressed regret that he had been too idle 
 to study English. Nevertheless he spoke our language 
 fluently, with an excellent use of idiom, and we were 
 able to converse freely. It was surprising to find that, 
 in talking to a person whom the common idea in 
 Europe would class generically as a barbarian, one 
 was talking to a man of the utmost refinement, with 
 the feelings and courteous manners of a gentleman, 
 the mental attitude of a high government official, 
 the detached view and sense of responsibility of a 
 far-sighted and trustworthy statesman. He talked 
 frankly and with horror of the Boxer outbreak ; he 
 admitted the blot it left on Chinese national honour 
 in the eyes of the world ; but he pointed out its 
 origin in the essential ignorance amongst all classes 
 in China of anything outside the Chinese Empire. 
 
RELIGION IN THE FAR EAST 279 
 
 The governing classes, too, shared this ignorance ; 
 and it was on this ignorance that clever and un- 
 scrupulous imperial favourites, with some knowledge 
 of the outside world, were able to play with so much 
 effect. There were, he considered, hardly half-a- 
 dozen officials of any standing in Pekin who 
 comprehended the reality of European power and 
 education, beyond the obvious triumph of inventing 
 fascinating toys and engines, such as battleships 
 and sewing machines, a feat which ranked their in- 
 ventors with the magicians. But these half-a-dozen, 
 including such men as Yuen-shi-kai, then Governor 
 of Chili, knew which way the wind blew, and a 
 similar rising was impossible in the future. 
 
 This, however, is a parenthesis. The retiring 
 Chinese Consul was a symbol to my mind of the 
 extremely high qualities of his countrymen, material 
 of the greatest potentialities for the work of the 
 political craftsmen, the moulder of states. When 
 his country arouses itself from its self-contentment, 
 actively, instead of passively, to face European ex- 
 pansion, it is with equal, if not superior, intelligence 
 and culture that the nations of the west will have 
 to deal. 
 
 At first we find it difficult to believe that this is 
 not an exaggerated view of the higher characteristics 
 in a people that can be guilty of such atrocities as 
 are a matter of common knowledge. To the traveller 
 this is a very great difficulty ; for he touches only 
 at the ports, he sees only the fringe, he hears 
 only the tales of intercourse with such unrepresenta- 
 tive sections of the Chinese people as deal with the 
 
280 HEALTH AND EMPIRE 
 
 foreign intruder. It was my own experience to see 
 the prosperous state of the Chinese community 
 imported into the Straits Settlements, primarily in 
 order to work the tin mines ; to witness the depar- 
 ture of the first shipload of carefully selected coolies 
 from Hong-Kong for South Africa ; to visit the 
 slums of Hong-Kong, the gambling dens of San 
 Francisco, and the workhouse, founded by Li Hung- 
 Chang on European lines, at Tien-tsin ; and to 
 witness the unlicensed looting of Russia-town outside 
 Niu-chwang in Manchuria, after its evacuation by 
 Russians and before its occupation by the Japanese, 
 a scene that will always live in my mind as a typical 
 picture of unbridled savagery and anarchy. 
 
 But when we think what perfect economical, 
 political and literary self-contentment means to a 
 people of 400,000,000, when we realise to how 
 small a degree that self-contentment has been 
 touched by European influence, and when, to help 
 the current of our thoughts, we read the personal 
 impressions of those who know the interior life of 
 China, Chinese, like Mr. Chiu, who have lived in 
 Europe ; acute thinking Europeans, like the best 
 missionaries, who have lived amongst the Chinese, 
 then we shall begin to realise that this estimate of 
 the high qualities of Mr. Chiu's race is in no way 
 exaggerated. There is merely an immense gulf of 
 misunderstanding or lack of understanding fixed 
 between the two types of mankind. For better or 
 for worse, the inexorable laws of human development 
 have decided that national seclusion shall now cease. 
 Our aim must, therefore, be to remove this lack of 
 
RELIGION IN THE FAR EAST 281 
 
 understanding and to secure gradual inter-penetration 
 on peaceable lines. For this purpose English readers 
 cannot do better than read Dr. Arthur Smith's 
 entertaining and valuable books entitled " Chinese 
 Characteristics " and " Village Life in China " ; 
 those of Mr. and Mrs. Archibald Little ; the volume of 
 essays entitled " These from the Land of Sinim," 
 by Sir Robert Hart, whose sympathetic and states- 
 manlike views of these questions after fifty years' 
 official life in the Imperial Customs is unequalled ; 
 and lastly, a little shilling pamphlet published a few 
 years ago by Brimley Johnson and entitled " Letters 
 from John Chinaman." 
 
 What then is the attitude of the Chinese towards 
 Christian Missions ? To answer this question, we 
 must first briefly estimate the religious and moral 
 standpoint of the Chinese. This is not very difficult, 
 up to the point we require. The moral standards 
 appear to be high and worthy of the Confucian code. 
 Polygamy being allowed, one chief form of vice is to 
 a large extent obviated. Indulgence in opium does 
 not, according to the small but very good evidence 
 given me, cause greater personal or domestic ravages 
 in China than does alcohol with us. Great as that 
 is, it is now steadily on the decline. Mutual help and 
 family duty and affection are marked characteristics 
 of a domestic life from which we may learn much ; 
 co-operation in trade-guilds is more universal ; and 
 government, if carried out with severity and some 
 personal rapaciousness on the part of the officials, 
 appears to be in accordance with principles under- 
 stood and recognised by the people, constant, firm 
 
282 HEALTH AND EMPIRE 
 
 and just. Official posts from the lowest to the 
 highest are open to the common child in any village 
 school by a complete system of examinations. The 
 Chinaman at home appears peaceable and hard- 
 working ; his outlook and his ambitions are confined 
 to very modest limits ; his honesty is proverbial. 
 It is doubtful if we in England follow the teaching 
 of the Gospels in our common life nearly so thor- 
 oughly as the Chinese villager follows the rule of 
 Confucius, as he has received it. 
 
 Religion, however, appears conspicuous by its 
 absence. However closely one may inquire into the 
 shadows of religious systems or the more obvious 
 glitter of ancestral worship, and seek to distinguish 
 the reasonable from the meaningless or preposterous, 
 one cannot but conclude that the Chinaman has no 
 conception of a personal God : has in fact no religion. 
 In Canton the traveller is taken to these wretched 
 temples, miserably kept up and evidently but little 
 frequented. The buildings were not striking ; and 
 the hall of 500 Genii, including amongst others Marco 
 Polo with his cardinal's hat, were empty of any 
 signs of devotion or use, except for the joss-sticks, 
 kept fizzling in front of some of the effigies by the 
 attendant. One temple, better maintained than the 
 others, was a Buddhist shrine with two huge Buddhas v 
 as a centre-piece and a dozen bronze saints in niches 
 on either side. But of public use and religion there 
 was no sign. 
 
 Ancestral worship, it seems clear, is essentially 
 derived from the same fear of the elements which 
 accounts for demon-worship in Central Africa or the 
 
RELIGION IN THE FAR EAST 283 
 
 polytheism of the Indian hill-tribes. In China 
 these powers of nature are in no way correlated to 
 the creation of the universe, but to the action of 
 departed spirits. And it is in fear of these departed 
 spirits that the people offer food, money and clothes 
 to help the dead in the other world, and prevent their 
 taking vengeance on their neglectful living de- 
 scendants. Amongst the uneducated classes this 
 amounts to a fear and a superstition ; amongst the 
 educated it implies a considerable ritual, hallowed by 
 domestic memories and accumulated custom, the 
 centre of their domestic and so of their national 
 life. Argument is powerless to overcome it. Habit 
 is stronger than reason. 
 
 Here then is the nucleus of Chinese feeling towards 
 the missionary. For the missionary, by Chinese 
 belief, is primd facie a foreign devil, possessed by a 
 destitute spirit, in search of vengeance for neglect 
 by his descendants. Hence, if plague or famine 
 break out in a place where a foreigner resides, it is 
 the foreign devil that has caused it and must be 
 driven away or, better still, exterminated so as no 
 longer to afford refuge for the spirit. This natural 
 public feeling may obviously be inflamed by in- 
 judicious propagandism or protection of evil char- 
 acters, by lack of education or sympathy on the part 
 of the foreigner ; but it may on the other hand be 
 mitigated by kindness and self-devotion, as medical 
 missionaries have especially found. One, already 
 quoted in this paper, habitually travelled alone up 
 to a hundred miles from Nankin without fear. He 
 spoke so soberly as to give confidence in his assertion 
 
284 HEALTH AND EMPIRE 
 
 that the missionaries are seldom the cause of riot in 
 China, but are often the victims of a general riot 
 against white men, promoted by the drastic and often 
 totally unprincipled action of traders, or militarists 
 like the Germans in Kiaochao, or the Roman Catholic 
 priests, bidden by papal order to assume Mandarin 
 rank as a Chinaman might come to England (if he 
 makes haste) and claim a seat in the House of Lords ! 
 Indeed, in the late Boxer troubles, started primarily 
 in a movement against an Italian trading company 
 in Shantung, the local missionaries were spared by 
 being able, after much trouble, to prove that they 
 belonged to the mission. 
 
 Is ancestor-worship, then, merely a system of re- 
 verence for the dead ? Surely not. The Jesuits, 
 indeed, in 1610, under Ricci, shortly after their 
 arrival in China in 1582, tolerated it ; the Dominicans 
 in 1651 forbade it. Emperor Rang Hyi, appealed 
 to by the Jesuits in 1699, replied : " The customs of 
 China are political" ; but Pope Clement XL in 1704 
 issued a papal bull, which still holds good, forbidding 
 it. Four hundred Protestant missionaries in con- 
 ference in Shanghai in 1900 discussed the plea of 
 Dr. Martin, President of the Chinese College at Pekin, 
 for toleration of the custom, wishing to " leave 
 reformation of the system to the influence of divine 
 truth " ; but the proposal was rejected, the conference 
 deciding that idolatry was an essential constituent 
 of the custom. Here we must leave it, convinced 
 in our belief that religion, in our sense of the word, 
 has no part in Chinese life or thought. 
 
 This chapter has dealt at length with the Chinese 
 
RELIGION IN THE FAR EAST 285 
 
 character, for this is the extreme point from which 
 all conclusions as to the relationship of Confucianism, 
 Buddhism and Christianity in the far east should 
 start. The essential Japanese mind and life, as 
 born into the life of the world by the overthrow of the 
 Shoguns in 1868, are deducible, though very different, 
 from the Chinese in the present day. Indeed, if we 
 eliminate the influences of the last forty years, all 
 that Japan is or has is derived from China. 
 Buddhism came over from China, and asserts itself 
 in symbols of art and letters even on the archways 
 torii of the Buddhist temples. The characters of 
 writing are Chinese ; the abacus, or calculator in 
 use in every shop and school, came from China ; 
 food and customs, as of ancestor-worship, forms of 
 government and methods of war, art in painting, 
 embroidery and architecture came across from the 
 mainland, following indeed the Japanese themselves. 
 But the Chinese, it is said, are the Germans of the 
 far east ; the Japanese are the French. The rich, 
 heavy, detailed embroidery, the ponderous brass- 
 work, the solid black -wood furniture, so highly 
 appreciated by the European community at Shanghai, 
 are but the forerunners of the delicate, gauzy silks, 
 with large flowing designs, the natural lifelike 
 bronzes, the light lacquer work of Japan. Japan 
 adopts the material and the conventions of China ; 
 but instils into them a wealth of versatile feeling, 
 giving them a new life, in keeping with her mar- 
 vellous life-giving spirit. China is essentially the 
 thoughtful originator. Japan is seldom the 
 originator ; she is the adapter. As in her inter- 
 
286 HEALTH AND EMPIRE 
 
 course with China, so in her history of the last forty 
 years, Japan has invented little ; but she has been 
 quick to seize on all that is best in every domain 
 of European civilisation, to adapt it to her own ends, 
 and gradually to develop it to suit her own purposes. 
 The medical schools, for instance, at Tokyo and the 
 half-dozen naval and military hospitals throughout 
 the country, showed an almost slavish imitation of 
 the German methods in which Drs. Baelz, Scriba, von 
 Scheube and post-graduate study in Germany have 
 instructed the Japanese doctors of to-day. These 
 methods were but adapted to the scanty financial 
 circumstances and the climate and the commonly 
 available materials of Japan. But it will not be 
 long before this adaptation in the light of active 
 experience will produce new developments of intrinsic 
 value. Japan is not an originator ; but she is a 
 remarkably good adapter. 
 
 Now in Japan there is considerable sign of the 
 presence of active religious feeling. Not in the 
 artistic wonders of the tombs of the Shoguns at 
 Tokyo, nor in those of the temples at Nikko and 
 Kyoto ; for of itself the art does not prove the 
 existence of the religious sense. But it was the new 
 temple at Kyoto, the Higashi Hongwanji, which was 
 most impressive as a sign of active religion (Plate 15). 
 The temple itself was erected only during the last 
 twenty years by small popular subscriptions amount- 
 ing to 100,000 in all, in the place of its historic 
 predecessor, burnt down. Entering into the great 
 nave, one morning, and sitting down on the padded 
 matting in a corner, one was first impressed by the 
 
A MODERN BUDDHIST CATHEDRAL IN JAPAN. 
 
 (a) The Hignshi Hongwanji, Kyoto, built in 1895. 
 The Interior : the Congregation and the Image displayed. 
 
RELIGION IN THE FAR EAST 287 
 
 sense of restful beauty, of grandeur and of repose, 
 both in the broad outlines of construction and in the 
 details of lacquer work and ornament ; but the effect 
 was still more impressive of seeing a devout con- 
 gregation of a hundred or so Japanese following a 
 service, strangely like that of the Roman Church. 
 From behind a barrier, separating nave from chancel, 
 came sounds of some sacred reading in clear and 
 definite tone ; after this was finished a priest in 
 fine robes advanced as it were to the altar ; in 
 absolute silence a bell was tinkled, and reverently the 
 shrine was opened, displaying the image of Buddha. 
 All bowed prostrate to the ground, and remained so, 
 it appeared, in silent prayer, for one or two minutes. 
 The bell again tinkled ; the doors of the shrine 
 were closed, and the people rose to leave the 
 temple. 
 
 It is difficult to say how much the Japanese feel 
 the profounder problems of the universe and the 
 need of a personal God. From the few learned and 
 good Japanese with whom I had an opportunity 
 of free conversation, it would seem that these matters 
 are of no interest to the enlightened classes. And 
 it will be realised that throughout the Japanese 
 Empire elementary education is in an advanced 
 state ; and in the towns, the halfpenny papers have 
 a wide vogue, even amongst rickshaw men and 
 labourers, so that what affects the upper, affects 
 also the lower classes. Religion would seem as yet 
 in general to have rather a practical than a senti- 
 mental or theoretical interest for them. But is this 
 surprising ? Is it not natural that, in encountering 
 
288 HEALTH AND EMPIRE 
 
 the civilisation of the west, they have first to establish 
 their material strength with a view to the survival 
 of the fittest among nations ; that they should be 
 first struck with the wonders of science and manu- 
 facture, and should direct all their energies to the 
 establishment first of their military and then of their 
 commercial position in the eastern seas ? For the 
 present, therefore, it can be well understood that 
 they are content to look for all that contributes 
 outwardly to make a nation great ; while, for their 
 credit in the eyes of the civilised world, they are 
 developing a more humane regard for weakness 
 in their care of women and children, their treatment 
 of the sick and wounded, of prisoners and criminals 
 and animals have adopted certain conventionalities, 
 such as the top-hat, black coat and starched collar 
 for official circumstances, to facilitate their treat- 
 ment by other nations on terms of equality ; have 
 constructed an enlightened judicial code ; and are 
 laboriously studying every form of knowledge and 
 experience in Europe and North America. 
 
 It is a quaint but somewhat mortifying fact that 
 not long ago a commission of Japanese students, 
 sent over to study European methods and manners, 
 reported the total severance of Christianity from 
 modern progress and modern European life. It 
 was on this report that it was decided not to pro- 
 claim Christianity the established faith of Japan. 
 For this result Christians may be thankful ; but 
 it reads them a very obvious lesson. It is possible 
 for Europeans, nurtured in the Christian faith, to 
 learn the meaning of religion, quite apart from the 
 
RELIGION IN THE FAR EAST 289 
 
 form the words in which the religion is expressed. 
 These words, these forms, were drawn up many 
 centuries ago. In common use the words and 
 phrases have often acquired a different meaning to 
 accord with modern scientific developments ; but 
 their religious use remains the same. In the spirit 
 in which our immutable religion was revealed to 
 the early Jewish and Christian churches, we still 
 believe in the resurrection of the body, we still read 
 with profit the first chapter of Genesis. But the 
 Japanese examine such documents with the critical 
 standards of modern scientific nomenclature ; and 
 do not, perhaps, realise that the exact order of 
 creation, the exact chemical significance of the risen 
 body, are of minor importance, and were never 
 part of the revealed religion to which alone we 
 subscribe. 
 
 Here, then, is the essential difficulty the mission- 
 aries have to face in China, as in Japan, though at 
 different stages of development. The missionaries 
 deserve the utmost honour and support. With few 
 exceptions, they are whole-hearted and zealous, even 
 to martyrdom ; and they stand to the credit of the 
 white races as the sole evidence that commerce, 
 Empire and selfish aggrandisement are not the 
 essence of their strength or the end of their aim. It 
 is for that reason that missionaries, however little 
 they may desire it, should be protected to the utmost 
 of our national power by our official representatives ; 
 for an insult to a missionary is an insult to his race, 
 not to his faith ; and if we do not officially protect 
 him, we lend colour to the suggestion that our public 
 
290 HEALTH AND EMPIRE 
 
 aims are purely commercial, militant and selfish. 
 The missionaries, however, do not as a rule make 
 out the best case for the Christian faith. Too often 
 they and their supporters at home cling to the letter, 
 when the spirit alone giveth life. Acknowledging as 
 they do the power of the Spirit, they cannot allow 
 the absolute unimportance of the phrases in which 
 it is cloaked. And so their gospel is concealed by 
 what to us is a true, but to the Asiatic an entirely 
 false, mantle of dogmatic creed. 
 
 Let us go further. Is it essential to Christianity 
 that it should be based on Old Testament history ? 
 This is the way in which it has been brought to us ; 
 but is it essential for the Asiatics, to whom the Jews 
 are of no importance and for whom they have no 
 interest ? May it be asked, humbly and reverently, 
 Had Our Lord been born in China or in Japan, would 
 He have begun His mission by preaching Jewish 
 tradition and history ? Would He not have taken 
 as His foundation all that is so noble and inspiring 
 in the doctrines of Confucius and grafted on that 
 His glorious revelation of the eternal purposes of 
 God? 
 
 I venture to suggest that from that and from no 
 other direction of investigation on the part of Chinese 
 and Japanese scholars and patriots can any con- 
 siderable spread of the Christian Church be possibly 
 expected in China or Japan. There can be do doubt 
 that the six English and American bishops of the 
 " Church of Japan " will be succeeded by Japanese ; 
 that the result of the recent war, as one of these 
 bishops confessed, will undoubtedly tend towards 
 
RELIGION IN THE FAR EAST 291 
 
 the independence of this Japanese Church, so soon 
 as it can be assured of financial stability, and that 
 any such Church, unless securely built into the rock 
 of Japanese tradition and virtue, will have to choose, 
 on the one hand, between the formal doctrines of 
 western Christianity, as we have learned it, involving 
 complete alienation from the life of the Japanese 
 people, and, on the other hand, such startling 
 developments as may lead to schism within and 
 separation from other branches of the Catholic Church 
 without. The possibilities of Christianity are well 
 shown in Tokyo by the wonderful labours of the late 
 Russian Bishop NicoM, who by his own magnetic 
 influence attracted 120,000 converts, so it was said, 
 to the Greek Church. It is for us to see that those 
 at home and those sent out as missionaries to the Far 
 East should be of the highest intellectual culture 
 possible, men of broad sympathy, high statesman- 
 like ability, and, it is needless to add, of glowing 
 faith and fervent zeal. Scholars from home are 
 wanted to interpret to the eastern the essential basis 
 of the Christian faith, in terms which they will under- 
 stand, in accordance with the life and history which 
 is part of themselves. The basis of their work must 
 be some such presentment of modern faith, if a filial 
 tribute may be permitted, as that by the Dean of 
 Ripon in his little book entitled " Natural Chris- 
 tianity." This is all that the west can do. The 
 seed must then be allowed to grow ; for it is to 
 Japanese and Chinese teachers and preachers, to 
 some Japanese or Chinese prophet that shall arise, 
 that the eventual development of a religious system 
 
292 HEALTH AND EMPIRE 
 
 must be left ; it is they that must evangelise the 
 mighty nations of Japan and China ; and it is He, 
 who hath begun a good work in our western lands, 
 that will in His own time and in His own way con- 
 tinue it in the countries we so little understand in 
 the Far East. 
 
CHAPTER XV 
 
 HEALTH-FAKING AT SAN FRANCISCO 
 
 THE serious effect of epidemic disease upon commerce 
 to which attention has constantly been drawn in the 
 preceding chapters is nowhere more strikingly shown 
 than in the extraordinary action of the municipal 
 officials at San Francisco in the first few years of 
 this century. The story on the one hand points to 
 the need of medical advice, and of due attention to 
 that advice, in the administration of public health ; 
 on the other to the financial value of health measures 
 and to the consequent miscarriage of justice that may 
 deliberately be effected by local officials, even of a 
 large city, when not properly supervised or controlled 
 by the central authority. 
 
 Plague broke out in San Francisco in the year 1900, 
 and it is not difficult to trace the steps by which the 
 dreaded epidemic thus reached the United States. 
 Extensive traffic between Japan on the one hand 
 and Formosa, Hong-Kong and other Chinese ports 
 on the other, is sufficient to account for the small 
 footing which plague obtained in Japan during the 
 course of the epidemic. In 1894, i case was recorded 
 as imported to Japan ; in 1896, 1897 and 1898 the 
 disease was imported three times in each year ; 
 and in 1899 six times. In December 1899 elaborate 
 393 
 
294 HEALTH AND EMPIRE 
 
 and most effective regulations were issued for the 
 management of plague at Kobe, the great central 
 port of Japan, Osaka, the chief manufacturing centre, 
 close by, and other districts that might be subse- 
 quently invaded by plague. Up to the 22nd Decem- 
 ber 23 cases and 19 deaths had been recorded at 
 Kobe ; but Professors Kitasato and Ogata were of 
 the opinion that plague was the cause of death in 
 most of 270 cases which had occurred in September 
 and October 1899 from acute pneumonia a disease 
 not at all common, it is said, in Japan in 230 deaths 
 attributed to acute meningitis ; and in 266 deaths 
 attributed to beri-beri. Kobe, be it noticed, has a 
 population of about 230,000. 
 
 At a meeting of the Central Sanitary Association 
 at Tokyo it was concluded that the disease was prob- 
 ably brought to Japan from Hong-Kong or Formosa. 
 By the reward of a penny for every rat brought to 
 the authorities in Osaka and Kobe, 3,050,000 rats 
 were killed in the eighteen months up to April 1901. 
 In Osaka about one-tenth, and in Kobe as many as 
 one-fifth, of these were found by bacteriological 
 experts to be suffering from the disease. In this and 
 other ways the disease has been kept in check, the 
 maximum number of reported cases in Japan in any 
 one year being 646, and the total number for thirteen 
 years, to the end of 1909, under 2500. 
 
 The epidemic was now spreading to the Sandwich 
 or Hawaiian Islands, the half-way house of most of 
 the trade routes between Eastern Asia and the United 
 States. On i8th June, 1899, the steamer, Nippon 
 Maru, from Hong-Kong and Japan for America, 
 
HEALTH-FAKING AT SAN FRANCISCO 295 
 
 landed a body which was found to have died from 
 plague. A few other cases were also found on ships 
 calling at Honolulu, but it was not till November 
 that the local authorities began to realise that the 
 infection had in reality gained a footing in the islands. 
 The earliest cases were recognised by a Chinese doctor 
 early in November, corroborated after post-mortem 
 examination by Dr. Hoffman, bacteriologist of the 
 Hawaiian board of health, and confirmed by bacterio- 
 logical investigation and by experiments on animals. 
 On I2th December, 1899, the board of health officially 
 declared plague to have broken out at Honolulu. 
 
 The amount of trade passing between the Sandwich 
 Islands, now part of the United States, and San 
 Francisco, is very considerable, and on 6th March, 
 1900, the dead body of a Chinaman was removed from 
 the Globe Hotel, in the Chinese quarter, death being 
 found, by bacteriological and inoculation experiments, 
 to have resulted from plague. The deceased China- 
 man had resided in San Francisco for fifteen years. 
 Two days later six suspected cases came under 
 observation in " Chinatown," and immediately the 
 local board of health instituted a general inspection 
 of the Chinese quarter, with scavenging of all pre- 
 mises. The Chinese consul and other influential 
 Chinese residents in San Francisco undertook to see 
 proper precautions carried out ; but by igih March 
 fresh cases began to be heard of in different parts of 
 the Chinese quarter, and in one of the fatal instances 
 post-mortem examination, followed by bacteriological 
 investigation, proved the death to have been due to 
 plague. It was evident to the authorities that the 
 
296 HEALTH AND EMPIRE 
 
 Chinese population were concealing cases in order to 
 escape inspection of their houses and removal of their 
 sick to the hospital. 
 
 On igth May the local board of health officially 
 declared the existence of plague at San Francisco. 
 Further house-to-house inspections were ordered, but 
 this measure was frustrated in a large degree by the 
 Asiatics keeping their houses barred and declining 
 to admit the inspectors. Railway and transport 
 companies were ordered to refuse tickets to Chinese 
 and Japanese unless they possessed certificates 
 granted by the health authorities. Inoculation by 
 Haffkine's prophylactic was freely offered, but little 
 use was made of it by the public. It is said that a 
 Chinese secret society, known as the " High Binders," 
 threatened to assassinate all Chinamen in San Fran- 
 cisco who submitted to the process. The Japanese, 
 on the other hand, largely submitted themselves to 
 inoculation. Reports were circulated of Chinamen 
 being made very ill and dying from the effects of in- 
 oculation, and this helped to keep the Chinese from 
 coming forward to submit to the operation ; but in- 
 oculation was insisted upon when Chinese residents 
 wished to travel from San Francisco. 
 
 The state of affairs now reached headquarters at 
 Washington, and a number of medical officers of 
 the marine hospital service were despatched to San 
 Francisco, to take part in railway and road inspection, 
 and to assist in carrying out the preventive measures. 
 Further inter-state quarantine regulations were 
 added to those already existing in May, 1890. The 
 matter was clearly one of national importance to the 
 
HEALTH-FAKING AT SAN FRANCISCO 297 
 
 whole of the United States. From 6th March to 
 the end of the year 1900, 22 cases, all fatal, were 
 officially reported ; 10 were verified by post-mortem 
 and bacteriological examination. None of these ten 
 cases came under the observation of the health 
 authorities during life. All were Chinese and had 
 lived in the Chinese quarter. In his annual report to 
 Congress for 1901 the secretary of the treasury re- 
 ported as follows : 
 
 " The existence of bubonic plague in San Francisco, which was 
 first reported on March 8th, 1900, and of which mention was made 
 in the last annual report, was confirmed by a commission appointed 
 by the department, consisting of three bacteriologists of the 
 highest reputation, who had had no previous connection with 
 government service. This Commission reached San Francisco in 
 February, 1901, and after an exhaustive investigation rendered a 
 report so conclusive in its nature as to result in measures being 
 taken to cleanse Chinatown, where the plague existed." 
 
 It was inconvenient, however, to the reputation 
 and commercial welfare of San Francisco that plague 
 should exist, or be even suspected to exist, within the 
 city. Neglecting the advice of their board of health, 
 the local authorities declared that it did not exist. 
 Notwithstanding the fact that the disease had been 
 proved, by post-mortem examinations, by bacterio- 
 logical investigation, and by experiments on animals, 
 to have existed in the bodies of the dead Chinese, 
 the governor, as reported publicly in The San 
 Francisco Chronicle of I4th June, 1900, convened a 
 meeting of the leading commercial men of the city, 
 at which a strongly worded protest was drawn up 
 and sent to the secretary of state, denying the exist- 
 
298 HEALTH AND EMPIRE 
 
 ence of plague, either then or previously. Some 
 medical men of no great repute, but connected with 
 the local authorities, signed this protest, giving only 
 vague reasons for their dissent from the declaration 
 of the board of health. No case, they said, had been 
 diagnosed as plague during life ; only n deaths had 
 occurred, as they put it, in a Chinese population of 
 35,000 ; there were no cases amongst whites ; in- 
 vestigation of the supposed plague cases had been 
 incomplete ; the recorded mortality from all causes 
 had not risen ; there was no proof that the so-called 
 plague had been transmitted from one person to 
 another ; there had been no multiple cases in families 
 in other words, they sheltered themselves under the 
 fact that the Chinese had done their utmost to defeat 
 the law, and the authorities to obstruct the investiga- 
 tion of the disease by their own board of health. 
 Finally, the allegation that plague existed in San 
 Francisco was characterised by the governor as an 
 aspersion upon the character of that " great and 
 healthful city," and it degraded San Francisco in the 
 eyes of the whole world. It is asserted that at a 
 later stage the governor of San Francisco, in a message 
 to the legislature alleged that 
 
 " certain physicians, having cultures of plague bacilli in their 
 possession, have, innocently or otherwise, inoculated the dead body 
 of a Chinaman with them, and that the finding of the germs in 
 such dead body has resulted in spreading a false alarm calculated 
 to strengthen the hands of Dr. Kinyoun, the federal quarantine 
 officer, and to induce the City of San Francisco to appropriate 
 more money for its board of health." 
 
 The action now taken by the mayor of San Fran- 
 
HEALTH-FAKING AT SAN FRANCISCO 299 
 
 cisco is hardly credible. On 25th March, 1902, with- 
 out previous warning of his intention, an order was 
 issued from his office, peremptorily removing those 
 members of the board of health who were appointed 
 by his predecessor, and substituting in their place 
 certain persons of his own selection. Each member 
 of the board received a letter of dismissal, giving 
 reasons for this action, but these letters were received 
 only after the newly appointed board had effected 
 an artificial organisation. The reason for this action 
 was said to be based upon the thorough investiga- 
 tion which the mayor said he had conducted into 
 the case. 
 
 The original board, however, with pluck and in- 
 dependence worthy of the race, refused to be deposed, 
 and on the following day made application for an in- 
 junction restraining the mayor, his attorney, and all 
 other persons from interfering with the members of 
 the board or their employees in discharging their 
 official duties, and prohibiting his Honour from in- 
 truding into the rooms or offices of the board. The 
 injunction was granted by the presiding judge of the 
 superior court, and the mayor brought a motion for 
 its dismissal, which was decided on igth May. It 
 was ruled that the old board maintained possession 
 of their offices until definitely ousted in the course of 
 legal proceedings by a writ of quo wananto. Such 
 proceedings were accordingly instituted by a clerk in 
 the mayor's office on 27th May, 1902, but it had not 
 yet come up for final hearing before the board of health 
 which refused to be deposed issued on $oth June 
 its annual report for the year 1901, a bulky 
 
300 HEALTH AND EMPIRE 
 
 volume of five hundred pages, with a long prefatory 
 letter, teeming with capitals and italics, which must 
 be quite unique in documents of this description. 
 
 " To the Honourable Eugene E. Schmitz [it began], Mayor 
 of the City and County of San Francisco. Sir : The Department 
 of Public Health of the City and County of San Francisco has 
 the honour to present for your consideration its Annual Report 
 for the fiscal year terminating on this date." 
 
 The report was a sweeping condemnation to his face 
 of the mayor's extraordinary action, no attempt 
 being made to conceal the motives which were sup- 
 posed to have promoted his action. The authors 
 regretted the absence of proper maps and charts, 
 owing to his Honour, despite funds having been pro- 
 vided by the finance committee of the board of super- 
 visors, having declined to approve of the expenditure. 
 A daily newspaper published in the city was quoted 
 as reporting the mayor to have accused the board of 
 health of incompetence for not issuing reports for the 
 two preceding fiscal years. It was shown that the 
 budgets of those fiscal years did not provide for the 
 printing of such reports. With remarkable candour, 
 the report declared that 
 
 " careful examination of the information contained in this 
 Report will indicate to one who is willing to be instructed the char- 
 acter and amount of work being accomplished under the direction 
 of this Board, and will further serve to demonstrate that the 
 Department of Public Health is conducted for purposes other 
 than the protection of political pets and the extravagant and unneces- 
 sary expenditure of municipal funds. During the past year much 
 official business has been transacted. . . . All dealings have been 
 conducted without serious differences ; and at present writing 
 
HEALTH-FAKING AT SAN FRANCISCO 301 
 
 this Department appears to exist in harmony with all branches 
 of the Municipality except the Mayor's office." 
 
 The history already narrated, as to the relations 
 between the mayor and the board of health, were now 
 set forth in detail, with much plainness of speech. 
 As to the thorough investigation said to have been 
 conducted by his Honour, 
 
 " it would appear as if said ' investigation ' were either vision- 
 ary or entirely ex parle. It will be remembered that shortly after 
 the induction of Your Honour into office the members of this 
 Board called to present their official respects, and at that time, in 
 response to a request to visit and inspect the operations of this 
 Department, Your Honour stated that such was your intention. 
 . . . There is no evidence, however, that Your Honour has ever 
 visited the Health Office since assuming the duties of Mayor, 
 except in one individual instance, when, supported by Your 
 Honour's attorney and accompanied by the gentlemen comprising 
 the so-called new Board of Health, and a staff of newspaper re- 
 presentatives, you invaded the rooms of the Department for the 
 purpose of taking possession thereof, and installing in office the 
 said so-called new Board of Health. There is no evidence to show 
 that Your Honour ever asked any member of the Board of Health, 
 or any responsible officer connected therewith, any question 
 whatever regarding the existence of bubonic plague in San Fran- 
 cisco, nor does it appear that Your Honour has ever sought to 
 examine the records in the Health Office for such facts as might be 
 presented on the subject, except on one occasion, when you asked 
 for a transcript of the report in a case of plague, which was dis- 
 covered by Federal officers, and by them reported to this Depart- 
 ment. Notwithstanding the failure or neglect on the part of Your 
 Honour to have submitted, for use in your investigation, the records 
 on file in this office, you assigned as a reason for the dismissal of 
 this Board the following: 'It is evident from recent instances and 
 developments, one as late as February 2ist, 1902, that you are 
 absolutely and unchangeably committed to the policy of main- 
 
302 HEALTH AND EMPIRE 
 
 taining, harbouring, and proclaiming this baseless bubonic plague 
 agitation, that you are proceeding even at this late date upon the 
 theory that every case investigated is a suspicious case, and that 
 every such case must be assumed to be and published as a true 
 case of bubonic plague until the contrary is so clearly established 
 by overwhelming evidence that the true disease can no longer be 
 concealed under the mask of the bubonic plague. This policy 
 is one of irreparable injury to the people whose protectors you are 
 supposed to be, it is against the welfare and prosperity of the city, 
 and is in my opinion ample and abundant justification for your 
 removal. . . . For three months past I have carefully examined 
 and investigated all accessible reports and records, and have 
 personally enquired into numerous specific cases reported and 
 declared by you, and under your authority, to have been cases of 
 bubonic plague, and I am unalterably convinced that, notwith- 
 standing your investigation and publications, bubonic plague has 
 not existed and does not exist in San Francisco.' ' 
 
 It is a mistake that officials should give a reason to 
 their inferiors for their action, and the late mayor of 
 San Francisco will meet with little sympathy in the 
 pillory to which he is thus subjected. Having ex- 
 pressed the resentment of the board at " the diaphan- 
 ous courtesy of an expressed regret " with which the 
 letter of dismissal ended, the report went on to enu- 
 merate the steps they had taken to enlighten the 
 public as to the actual conditions. 
 
 The facts of the existence of the plague are set 
 forth with brutal frankness : 
 
 " If Your Honour will consult the last two Annual Reports 
 issued by this Department, a brief statement will be found in 
 each." 
 
 " Notwithstanding Your Honour's assertion that you have 
 carefully examined and investigated all accessible reports and 
 records relating to plague, you are again reminded that the reports 
 
HEALTH-FAKING AT SAN FRANCISCO 303 
 
 and records on file in the Health Office, as well as those in posses- 
 sion of the Marine Hospital Service, have not as yet been consulted 
 by you." 
 
 " In summing up the result of Your Honour's investigation, you 
 have neglected to mention the Report of the Federal Commission 
 on this subject, which was issued as an Official Bulletin by the 
 United States Treasury Department, and has been accepted as an 
 authoritative opinion by all who possess sufficient intelligence to 
 appreciate the standing of the members of the Commission and 
 the character of the investigation conducted by them. Your 
 Honour has also omitted to note the reports of medical men from 
 Honolulu on file in the Health Office, or the report of the Health 
 Officer of British Columbia, who spent several weeks in San Fran- 
 cisco conducting an investigation." 
 
 " Your Honour has also failed to make reference to the report 
 of Dr. H. L. Ryfkogel, of this city, formerly Bacteriologist of the 
 State Board of Health, whose report was suppressed by the Board 
 under which he served, and who was deposed from his position by 
 order of the Governor, and was further refused payment for the 
 services he performed, all of which occurred because he had found 
 plague, and had sufficient courage to declare it in spite of the 
 Executive displeasure." 
 
 The Board of Health next proceeds to pillory the 
 
 " Report of the Special Health Commissioners appointed by the 
 Governor to confer with the Federal authorities at Washington 
 respecting the alleged existence of bubonic plague in California ; 
 also Report of State Board of Health. The purpose of this Report 
 is palpably one of deception. Its contents add nothing whatever 
 to scientific information, and its conclusions contribute still less 
 to veracity. ... It scarcely seems reasonable that a Commission 
 made up of editors, an attorney, and a manufacturer, no matter 
 how distinguished, should possess the scientific qualifications which 
 render their judgment in matters appertaining to any disease, and 
 particularly plague, superior to that of a Commission consisting 
 of the leading bacteriologists of the United States, such as was the 
 confidential Commission appointed by the Honourable Secretary 
 
304 HEALTH AND EMPIRE 
 
 of the Treasury, with the approval of President William McKinley. 
 . . . Little need be said about the professional evidence secured 
 by the Special Health Commission and the State Board of Health. 
 It may be true that the influence of the Commission has been 
 potent in producing the testimony of medical men subversive of 
 truth and in contempt of medical ethics. It may be also true that 
 there are physicians in public office who are sufficiently pliable to 
 forget at will the duties of their calling, and bow their heads in 
 response to the dictum of a political power. It may likewise be 
 true that, when gifts of lucrative appointment or military title are 
 held forth as inducements to depart from paths of professional 
 rectitude, the bait is too alluring to meet with resistance on the 
 part of some who yearn for the trappings of gilded pomp, or crave 
 for a little brief authority." 
 
 In the last page of their preface, this defiant if it 
 were not for the justice of their cause one would say 
 insolent Board of Health come to business. 
 
 " The Board of Health now announce to you that since 
 March 6th, 1900, fifty-seven cases of bubonic plague have been 
 observed by this Department, twenty- three of which have occurred 
 during the fiscal year ending this date. The discussion of plague 
 in this report is now closed. 
 
 " The prospects of satisfactory work under direction of this 
 Board, for the coming fiscal year, appear favourable. The Board 
 of Supervisors has made liberal allowance in the Budget for this 
 Department in all its branches. The members of this Board 
 regret exceedingly that Your Honour saw fit to exercise the veto 
 power upon so many of the very important items provided for this 
 Department in the annual Appropriation, but we view with satis- 
 faction and pleasure the recent action of the Board of Supervisors 
 in permitting the Budget to remain unmutilated. We feel con- 
 fident that, had Your Honour possessed a more intimate acquaint- 
 ance with the actual work of the Department of Public Health, 
 and had not listened so willingly to its detractors, your veto might 
 not have been applied so freely." 
 
HEALTH-FAKING AT SAN FRANCISCO 305 
 
 The Board are able to devote one short paragraph 
 to the congratulation of his Honour on his action 
 which resulted in the provision of a special tax for 
 the erection and maintenance of a new City and 
 County Hospital. They conclude by declaring with 
 biting sarcasm : 
 
 " It is difficult to determine whether membership on the Board 
 of Health of this City and County is to be looked upon as a crime 
 or as a joke. If it be the latter, the sooner the Charter is amended, 
 so as to permit of the appointment of editors and professional 
 politicians to such membership, the sooner will the city be safe- 
 guarded from the dangers which threaten it through the mis- 
 directed efforts of medical men, who persistently decline to have 
 their opinions manufactured to order. If it be a crime, informa- 
 tion should be filed with the Grand Jury, which will tend to bring 
 about the indictment of the criminals and their subsequent 
 obliteration from the official community. 
 " Respectfully submitted : 
 
 " (Signed) JOHN M. WILLIAMSON, M.D., 
 " President, Board of Health." 
 
 Many persons used to official work in this country 
 will read with growing impatience the disdain and 
 disrespect for authority shown, and, indeed, insisted 
 on, in these paragraphs. But it must be remembered 
 that the writers of those paragraphs were fighting 
 with the mayor to whom they made that report, not 
 only for their own existence as a board, but far more 
 for the welfare and safety of San Francisco, and for 
 the deliverance not only of their fellow-citizens, but of 
 California and the whole of the United States, from 
 that terrible danger which in India has cost us 
 7,000,000 lives, and may, for all we know, work fear- 
 ful ravages if ever it be allowed to gain a foothold 
 
306 HEALTH AND EMPIRE 
 
 in a white population. No honeyed words or official 
 courtesy would sufficiently express their sense of the 
 grave injury which might result through the action 
 of the local authorities ; the blind eye, they were 
 determined, should no longer be turned towards the 
 unmistakable facts of the case. It was war to the 
 knife, but, if they should perish in the attempt, they 
 would anyhow have done their best to save their city, 
 their state and their country from a terrible danger. 
 
 Fortunately they did not have to fight their battle 
 alone. A special commission, as I have already said, 
 was sent from Washington, and, in accordance with 
 an agreement between the federal department, the 
 authorities of the state of California and the city of 
 San Francisco, the work of inspection, isolation and 
 disinfection in Chinatown, San Francisco, was carried 
 on by a corps of physicians and employes of the state 
 and city, under the advice and direction of a surgeon 
 and a corps of assistants of the marine hospital service. 
 The work was completed on 2ist June, 1901, at which 
 time, 1180 houses, containing 14,117 rooms had been 
 disinfected, the burden of expense falling upon the 
 local and state authorities, the federal treasury paying 
 only the salaries and incidental expenses of its own 
 officers. This work being completed, a skeleton- 
 organisation was maintained for the purpose of 
 making examinations of the sick and dead in China- 
 town and assisting, when requested, in the dis- 
 infection of premises where cases were found. From 
 the beginning of the outbreak to the end of 1901 
 over 50 cases were found. 
 
 On the occasion of my visit to San Francisco in 
 
SAN FRANCISCO. 
 
 (a) Outwardly: In Market Street. 
 
 Inwardly : Where Plague broke out, in the Old Globe Hotel, Chinatown, and 
 the Federal Service was now giving it a thorough clear-out. 
 
HEALTH-FAKING AT SAN FRANCISCO 307 
 
 September, 1904, the laboratory of the marine hospital 
 service, the federal institution with headquarters 
 at Washington, was in full swing and Dr. Blue and 
 two others engaged in the work of stamping out 
 plague took me round Chinatown to see the measures 
 they were conducting for the purpose. Their tact 
 evidently had taken effect. We were admitted in 
 and out of barred opium dens, in which, previous to 
 their arrival, it would have been easy to hide cases 
 of plague. 
 
 " Dens " is an appropriate name for these squalid 
 hovels. Doors and windows were made fast and 
 windows covered ; there was little or no ventilation 
 for lamp, fire, or opium smoke ; and only the smallest 
 shaft of light, if any, came dow r n a chimney-like 
 opening at the back of the diminutive premises. 
 We were only admitted after being inspected, as at 
 the door of a convent, through a little window looking 
 into the dark passage by which we approached the 
 door, so that the inhabitants might convince them- 
 selves that we were not police. The police, however, 
 very seldom raided the opium dens and the fantan 
 or gambling-houses, as the Chinese born in the 
 country (and others are not now admitted) have 
 votes, on which the judges and officials depend for 
 political support. We went down to the basement 
 of the old Globe Hotel, where the plague first broke 
 out in 1900, a fifth-rate eating-shop on the edge of 
 the Chinese quarter (Plate 16). The plaster was 
 down from the walls and ceilings, and the basement 
 was being cemented, the uncemented part standing 
 an inch deep in water. It was easy to imagine 
 
308 HEALTH AND EMPIRE 
 
 the conditions which fostered the outbreak of 
 plague. 
 
 Dr. Blue and his staff in 1904 believed in soil in- 
 fection as the chief agent, independent of rats, and 
 the measures on which they therefore depended were 
 the cementing of basement floors and the occasional 
 pulling down of insanitary buildings. It was a pity 
 that no doubt for good official reason through- 
 ventilation was not aimed at, even in new or renewed 
 houses. Building seemed to be taking place on any 
 and no principle ; but my friends had undoubtedly 
 made one most useful step in advance in gradually 
 insisting on concreted basements in all houses of those 
 miserable slums. From February that is, for over 
 six months the city had, so far as they were able to 
 tell, been entirely free from plague. 
 
 It is well to know that the danger of plague secur- 
 ing a foothold in San Francisco was recognised by 
 other states as one of more than merely local im- 
 portance. The concealment of plague by the officials 
 at San Francisco excited lively indignation in other 
 state boards of health, and this feeling found expression 
 in their motions and minutes. As an example may 
 be taken the report of a committee to which the 
 matter was referred by the state board of health of 
 Iowa. They were 
 
 " forced to believe that facts pertaining to the true and exact 
 conditions then existing were purposely and unwisely withheld 
 from health boards and sanitary authorities, directly interested, 
 by the officials of the state of California and by the marine 
 hospital service for commercial reasons and against the best 
 interests of the people of all the states." 
 
HEALTH-FAKING AT SAN FRANCISCO 809 
 
 They protested 
 
 " against this policy of suppressing facts, and putting the 
 commercial interests of any state or community above that of 
 public health." 
 
 Whatever the exact result of the proceedings 
 between Mayor Schmitz and the board of health he 
 had sought summarily to dismiss may have been, the 
 fact remains that the report of the department of 
 public health in 1904, a couple of months previous to 
 my visit to San Francisco, was signed by a new pre- 
 sident, James W. Ward, and contained no mention 
 of the plague. It stated that, from 30th June 1903, 
 for six months, the chairman of the board of health 
 was a layman who submitted no report to the board 
 as to the service during the first half of the fiscal 
 year. 
 
 Since then, the commissioners constituting the new 
 board of health had sought to fulfil a policy of general 
 upbuilding of the department. Through the un- 
 stinted efforts of Dr. W. C. Hassler, the chief of the 
 sanitary bureau, insanitary conditions through the 
 city, especially in the Chinese district, were being 
 actively corrected. An ordinance had been pro- 
 posed to compel property-owners to make their 
 basements and cellars rat-proof. The basements 
 and cellars of four large blocks, containing 125 
 buildings, had thus been condemned, deprived of 
 their wood floors, partitions and ceilings, and con- 
 creted. The crusade against the general insanitary 
 condition of Chinatown had been most energetically 
 followed. From a place of filthy accumulations and 
 
310 HEALTH AND EMPIRE 
 
 infectious odours it had become one of comparative 
 and habitable cleanliness. It was proposed to buy 
 a portable steriliser, to assist in the disinfection of 
 certain contents of premises that would otherwise 
 require destruction, and to insist on the disinfection 
 and stamping as disinfected of all fabric merchandise 
 exported from Chinese quarters. The co-operation 
 between the United States public health and marine 
 hospital service, the state board of health and the 
 commission for public health of the city and county 
 of San Francisco had resulted in the organisation of 
 a " Public Health Commission of California," with 
 past-assistant surgeon Dr. R. Blue as its president, 
 in order by monthly meetings to promote interchange 
 of ideas and to enable the members to look at public 
 health from a wider standpoint than would otherwise 
 be possible to them. 
 
 The story of the graft-conspiracy in California and 
 its eventual defeat reads like a criminal romance of the 
 most fantastic kind. It was well told in The Times 
 of 2$rd January, 1907, and ist and 2nd January, 
 1908, and there is no room to repeat it here. But 
 readers of this chapter will want to know the back- 
 ground and the sequel of the incident here related. 
 
 It was due to a grant by the legislative of a well- 
 meant but ignorant charter in 1898 that the hitherto 
 good administration of San Francisco was put under 
 the absolute control of the popularly-elected mayor. 
 In 1901 an extremely able and unscrupulous French 
 Jew, named Abraham Ruef, secured by a small 
 majority through the support of the powerful labour- 
 unions the election to the mayoralty of Eugen Schmitz, 
 
HEALTH-FAKING AT SAN FRANCISCO 311 
 
 with himself as his recognised adviser. Schmitz at 
 the time, having failed in various business enterprises, 
 was president of the musicians' union and leader of 
 a theatre orchestra at a salary of 8 per week. By 
 labour-union votes he was re-elected to the mayoralty 
 in 1903 and 1905. The earthquake and fire occurred 
 soon after the election of 1905, and formed an oppor- 
 tunity for extending on a vast scale the system of 
 blackmail and corruption which Schmitz and Ruef 
 had been gradually constructing. By the end of 1905 
 the most powerful system of " graft " ever evolved 
 was in full operation, and the proceeds must have run 
 into six or seven figures sterling. 
 
 The salvation of San Francisco was wrought by 
 four men : Mr. Rudolph Spreckels, millionaire ; Mr. 
 Francis J. Heney, federal district attorney ; Mr. 
 Fremont Older, editor of The San Francisco Bulletin ; 
 and Mr. William J. Burns, a secret-service detective 
 in federal employ. The story of corruption that 
 they revealed was incredible, and the difficulty of 
 gaining a fair trial and of securing evidence was 
 immense. 
 
 Finally, however, on 8th July, 1907, Judge Dunne 
 sentenced the ex-mayor to prison, and added : " You 
 will suffer the humiliation of knowing that your career 
 of hypocrisy, duplicity, and dishonour has been ex- 
 posed, and that you stand before those who believed 
 in and honoured you morally naked, shamed and 
 disgraced." 
 
 To a group of newspaper men around him Schmitz 
 announced that he would again be candidate for 
 the office of mayor in the following autumn. 
 
812 HEALTH AND EMPIRE 
 
 Ruef also was subsequently condemned, but was 
 liberated on enormous bail ; Schmitz, on release in 
 1908, gloried in having spent a term in gaol, giving 
 a banquet to the embezzlers and other criminals who 
 were in prison with him. 
 
 But the power of recovery in such a community is 
 astonishing. The loss of property from the fire is 
 reckoned at over 70,000,000 ; but the total assessed 
 value of all buildings in the city exceeds to-day by 
 4,000,000 sterling that of the buildings assessed before 
 the fire in 1905. Thirty-five million pounds have 
 been spent in building since the fire, and in spite 
 of the " graft " scandals, in spite of the fire, in spite 
 of the recent financial depression in the United 
 States, the loss has been made good. 
 
 It is evident that the stand made by the best medi- 
 cal men in San Francisco against the deliberate 
 burking of evidence and shameful neglect of their duty 
 on the part of the local administrative authorities 
 had as its result the stamping out of plague from the 
 western door of the United States. In this reflection, 
 apart from other considerations, the members of 
 the health board will feel well rewarded. The sub- 
 sequent condemnation and imprisonment of the 
 mayor and his accomplices in these astonishing 
 " graft-scandals " will have been far less gratifying to 
 them than the purification of municipal affairs under 
 a sterling representative of their own profession in 
 Dr. Edward Robeson Taylor. In a progressive com- 
 munity of motley complexion, devoid of tradition 
 and independent of the outer world, the qualities 
 required of an administrator are pre-eminently those 
 
HFALTH-FAKING AT SAN FRANCISCO 318 
 
 required of the medical man, as attributed to the ideal 
 physician in daily life by Robert Louis Stevenson. 
 Stevenson's memory in San Francisco is aptly pre- 
 served by a little Spanish galleon, standing on a granite 
 pedestal in Portsmouth Square, with sails bellying 
 out before the wind, filled with the breezy vigour of 
 his man-compelling books. How his spirit must 
 have revelled in the triumph of the health-board over 
 the product of corrupt democracy ! 
 
 Prig-like, we may be inclined to give thanks that 
 our municipal life is incapable of such corruption. 
 But it is a fact to which every medical officer even in 
 this country will testify that, time and again, youth- 
 ful enthusiasm and mature and wise counsel for the 
 public good are alike suppressed in municipal service 
 by a slovenly or slothful, timorous or pig-headed re- 
 fusal to budge from precedent, to listen to new ideas, 
 to risk on an experiment the life of a dog or the health 
 of one individual, where the health and happiness of 
 thousands are yearly sacrificed by preventable causes. 
 Evil is just as prevalent under the smooth-faced, 
 press-flattered democracy of to-day as under many a 
 mediaeval tyranny ; just as hateful in the enlightened 
 and wealthy corporations of the old world as in the 
 wild-oat-sowing, hustling municipalities of the new. 
 The public standards differ ; the contrasts over there 
 are more marked ; nothing can escape advertise- 
 ment. But the responsibilities on this side of the 
 seas are as great ; humanity is as frail ; and humanity 
 in public servants, not least when engendered by the 
 soul-inspiring training and ideals of the healing art, is 
 hardly less generous or strong than in the upholders of 
 
314 HEALTH AND EMPIRE 
 
 the public health throughout the " graft-scandals " 
 of California. 
 
 The true instincts of the medical man are for the 
 elaboration of truth and the service of the world. 
 It is well that the public should occasionally be 
 reminded of the extent to which this spirit of innate 
 patriotism imbues the whole profession, in all countries 
 and in all societies, even in face of the blind eye of the 
 egregious Mayor Schmitz, of the city of San Francisco. 
 
CHAPTER XVI 
 
 FEDERAL HYGIENE IN THE STATES 
 
 WE talk a great deal nowadays of the glorious 
 possibilities of the British Empire. It has grown 
 up haphazard, despite the efforts of the British public 
 to forget it, of politicians to be rid of it. We now 
 see we selfish people of the motherland that 
 the empire is one of our greatest assets. But in the 
 struggle of the nations for survival of the fittest 
 haphazard arrangements are of no use ; our sense 
 of the artistic, poetic and natural must be violated, 
 the empire, if it is to continue, must be organised. 
 We talk therefore of imperial defence and of com- 
 mercial bonds within the empire. I venture to 
 add the suggestion in this book of imperial defence 
 against epidemic disease. 
 
 It is significant that our own offspring should teach 
 us many lessons of the greatest importance in our 
 task of empire management ; and, as we look for 
 many internal political experiments to New Zealand, 
 so we look for the result of many experiments in 
 co-operation between different governments under 
 one head to the United States of America America 
 more than Germany, because of the essential and 
 congenital analogies, both in individual character 
 and in public administration, between our American 
 cousins and ourselves. 
 315 
 
816 HEALTH AND EMPIRE 
 
 Such organisation of the public health under the 
 federal government is found in germ in the " United 
 States Public Health and Marine Hospital Service/ 1 
 This organisation is unique ; independent of the 
 navy or army, it works under a central bureau at 
 Washington, and superintends, or at least super- 
 vises, the health of every port in the United States. 
 The marine hospital service has its headquarter 
 buildings and publishes its official documents in 
 Washington, where it occupies in a small way the 
 position of the sanitary department of our Local 
 Government Board or of the ministry of the interior 
 in a continental capital. The marine hospital, as 
 this building is called, is a glaring misnomer ; in 
 Washington there is no marine and in this particular 
 building there is no hospital. But it represents 
 the department which has to do with quarantine 
 and the sanitary protection of the marine or sea- 
 faring mercantile community throughout the whole 
 of the United States. It represents a federal board 
 of health, and was established by an Act of the 
 United States Congress as a result of the panic 
 created by the spread of yellow fever in the Southern 
 States in 1878. Health-legislation how well we 
 know it in England usually has to wait until so 
 many innocent victims have died for the people. 
 This change was in keeping with the general principles 
 of American government, by which centralisation 
 is extremely difficult and is only attempted when 
 obviously necessary in matters such as those of 
 diplomacy, public defence and the tariff. Defence, 
 however, against infectious disease from without 
 
FEDERAL HYGIENE IN THE STATES 317 
 
 is equally a matter for national rather than for 
 local action ; and so it was thought sufficient to 
 establish a national public health bureau for this 
 purpose alone by means of the marine hospital 
 service. The term " quarantine service " would in 
 reality better explain its functions. While re- 
 pudiating all intention of interfering with the state 
 legislatures, this service, on behalf of the federal 
 government, has sent its commissioners to the 
 different seaport towns to supervise the arrival of 
 foreign persons and merchandise and deal with 
 them under the orders of the central government. 
 Thirty-nine quarantine maritime stations had in 1904 
 been thus established. 
 
 This system was primarily directed against the 
 foreigner, but it was before long extended to the 
 " enforcement of rules and regulations made by the 
 secretary of the treasury to prevent the introduction 
 of contagious or infectious diseases into the United 
 States from foreign countries, and into one state 
 or territory from another." If the municipal or 
 state authorities do not apply such regulations 
 efficiently, the national government has a right to 
 appoint its own officials to enforce due observance 
 of the rules. The next step taken towards co-opera- 
 tion between the states was the issue by state, 
 municipal and port sanitary authorities of weekly 
 reports of the sanitary condition of ports and places 
 within the states. The United States as a nation 
 claim thus at least the right to know what is taking 
 place within each state. But there are no funds 
 available by which experts may be sent to hold local 
 
318 HEALTH AND EMPIRE 
 
 courts of inquiry and report, as is done by our Local 
 Government Board. 
 
 A still further step is that the supervising surgeon- 
 general of the marine hospital service, under the 
 direction of the secretary of the treasury, has now a 
 right to do more than inquire as to the disease in each 
 state ; he has the right, by an Act of 27th March, 
 1890, to promulgate such rules and regulations as 
 may be necessary to prevent the spread of that disease 
 from one state or territory to another, the Act im- 
 posing a fine of five hundred dollars, or two years' 
 imprisonment, for the violation of such rules. 
 
 But it is one thing to prevent disease being im- 
 ported to any country or state ; it is another to take 
 precautions which may prevent such disease taking 
 root. It is just this power which is lacking at 
 Washington. According to the intelligence and 
 activity of local authorities, so is the chance of any 
 particular state of escaping infection. Where, as 
 too often happens, the authorities are not particularly 
 intelligent, or, as at San Francisco, are too afraid of 
 vested interests and the displeasure of local leaders 
 to carry through even the most necessary measures 
 of sanitation, there the sword of Damocles will always 
 hang, and an outbreak may at any time occur. As 
 at San Francisco, it may then be of considerable 
 use to send a special commission to assist the local 
 authorities in the administration of measures to 
 exterminate the disease or, to a large extent, to 
 supplant them ; but in many cases the horse is stolen 
 before the stable-door is locked. By degrees the 
 United States, like ourselves and other powers, 
 
FEDERAL HYGIENE IN THE STATES 819 
 
 will doubtless recognise the value of such centralisa- 
 tion of sanitary administration ; and, although 
 opposed to the spirit of the American nation and 
 constitution, as is the army, as is the navy, it will 
 no doubt be effected within the next fifty years. 
 
 The marine hospital service finds considerable 
 assistance in a law administered by the department 
 of agriculture, and dated 3rd March, 1891, under the 
 title, " An Act to provide for the inspection of live 
 cattle, hogs, and the carcases and products thereof, 
 which are subject to inter-state commerce, and for 
 other purposes." Similarly, more recent regulations 
 forbid the sale of vaccine lymph, antitoxin serums 
 and other similar articles, unless produced by licensed 
 manufacturers working under the supervision of 
 inspectors appointed by the federal government. 
 In the making of lymph and the canning of meat, 
 the principle of national control is admitted ; but 
 national control of the imported disease is far easier 
 and less open to opposition, and it is this work which 
 is the principal and most striking function of the 
 marine hospital service. 
 
 When the existence of plague in San Francisco 
 came to the ears of the government, it was this service 
 which sent a federal commission in 1901 to inquire 
 into the state of affairs. For three years Dr. Blue 
 and his assistant had, by arrangement with the local 
 authorities, been busily engaged on the sanitation 
 of the slums, and as a result plague appeared to 
 have died out. In the week ended I3th August, 
 1904, over 2000 rooms had been inspected, and over 
 2500 persons ; 4 dead had been examined ; 41 rats 
 
320 HEALTH AND EMPIRE 
 
 had been examined bacteriologically ; over 200 
 places had been limed and disinfected ; the Danysz 
 virus for extermination of rats, conveying to them a 
 bacillus which is death to them but harmless to man, 
 had been spread throughout ten blocks of buildings ; 
 and various details of sanitary work had been effected. 
 
 These facts are quoted from the weekly reports 
 of the public health and marine hospital service. 
 This weekly bulletin is the model statement of the 
 facts on which the work of such a federal department 
 should be based, and is highly suggestive for our 
 own use. It consists of two parts, the first affecting 
 the United States ; the second, foreign and insular, 
 concerning all other parts of the world. The reports 
 are addressed, directly or indirectly, to the surgeon- 
 general at the head of the service, and give a clue 
 to the many-sided, thoughtful and statesman-like 
 work in which the members of the service are engaged. 
 
 Let us run through the contents of the bulletin 
 in any particular week, that for instance in the week 
 ending I3th August, 1904. Through the director 
 of the hygienic laboratory at Washington, evidently 
 an appanage of the marine hospital service, the 
 chief of the division of zoology sends a preliminary 
 report upon an investigation into the so-called 
 " Spotted Fever " (tick-fever, or pyroplasmosis) of 
 the Rocky Mountains, the result being negative 
 to the usual theories of the disease. Allusion has 
 already been made to a second report that on the 
 work at San Francisco. A third report announces 
 the discovery of the anopheles mosquito in Key 
 West, due credit being given by name to the medical 
 
FEDERAL HYGIENE IN THE STATES 321 
 
 undergraduate who made the discovery. Work is 
 reported on account of smallpox in Northern Maine, 
 on the Canadian border ; other work on account of 
 yellow fever in Texas, and especially on the lower 
 Rio Grande, and the proceedings of the inspection 
 service along the Mexican border. Notice is given 
 of yearly and monthly reports of the chief facts, 
 statistical or otherwise, concerning the public health 
 of the various states and cities, with a discussion of 
 the mortality figures for June in New York state and 
 city ; and reports are given as to the alien immigrants 
 arriving at the various ports during the preceding 
 week and month. 
 
 An eye is thus kept upon serious illness of an 
 epidemic character affecting any part of the United 
 States, special commissioners being sent down to 
 investigate any unusual outbreak, as Dr. Blue was 
 sent down to San Francisco, or as Dr. Bulstrode 
 might be sent down to inspect oyster-beds at 
 Whitstable. These reports are followed by tabular 
 reports from all national quarantine and inspection 
 stations, enumerating the vessels that have sailed 
 or arrived, with certain details concerning their 
 freight, and any action that may have been taken 
 for their disinfection. 
 
 The first part of the weekly bulletin ends, in this 
 particular instance, with tables of all the smallpox 
 cases reported for the previous two months from 
 every part of the United States, over 2500 in number, 
 with 60 deaths ; a similar report of yellow fever, 
 6 cases in six months ; of plague in California for 
 the previous four and a half years 22, 30, 41, 17 
 x 
 
322 HEALTH AND EMPIRE 
 
 and 9 cases respectively, only 6 of which recovered ; 
 and the weekly mortality table from the chief causes 
 of death of some sixty cities of the United States. 
 
 So far, we may say, there is nothing very original 
 in this bulletin. The weekly mortality table does 
 not in any way correspond in importance and care 
 of production with the weekly report of our registrar- 
 general ; there is no systematic record of deaths 
 notified for the several parts of any area, correspond- 
 ing to that now issued by the local government 
 board for England and Wales ; and in this country 
 the detailed reports of the medical officer of our local 
 government board, although rare in their appearance, 
 give the public ample opportunity of knowing for 
 themselves what our central department is doing, 
 so soon as it can be published with sufficient pre- 
 caution to prevent misunderstanding. 
 
 It is the second part of the United States bulletin 
 that may attract our attention for a few pages. It 
 consists of a detailed and full series of reports con- 
 cerning the public health at every port of importance 
 throughout the world. We open upon the official 
 report of plague in the Cape Colony, issued from the 
 colonial secretary's office at Cape Town on nth 
 July. This bulletin is issued five weeks later. The 
 next report is from the department of public health 
 at Brisbane, dated six weeks previously and for- 
 warded by the consul-general at Melbourne, giving 
 details as to the rats and mice examined at the 
 bacteriological institute and destroyed during June, 
 and as to the results of treatment in the plague 
 hospital. A similar report on plague in rats and man 
 
FEDERAL HYGIENE IN THE STATES 323 
 
 is sent from Sydney, and another from Western 
 Australia, also forwarded by the consul-general at 
 Melbourne. The consul at Bahia, with less complete 
 opportunities, reports the cause of death for all 
 bodies buried during July in the Bahia cemeteries 
 and the occurrence of fifteen cases of smallpox in 
 the last half of the month. An acting assistant 
 surgeon reports the vessels and cargoes leaving Rio 
 and the measures taken to prevent the spread of 
 plague in Brazil, including the use, at least in hospital, 
 of " anti-pest " serum and vaccine. A note follows 
 as to the installation of a complete disinfecting plant 
 in the port at Para, with a general report upon the 
 mortality and sanitary condition of Rio a couple of 
 months previously. Reports are published from 
 British Honduras and Canada, giving in the latter 
 instance the number of immigrants rejected after 
 inspection. The next report deals with China, on 
 the authority of past-assistant surgeon White, giving 
 an account of plague, smallpox and cholera in the 
 various districts of Southern China, the maintenance 
 of quarantine at nearly all oriental ports against 
 arrivals from Hong-Kong and details as to the 
 ravages of an epidemic disease, believed to be rinder- 
 pest, in the jungles of Lower Burmah. The reports 
 from Limon, a fruit-port in Costa Rica, and from 
 Panama are of importance in connection with the 
 canal, while that from several parts of Cuba shows 
 the conditions for which the states undertook tem- 
 porary responsibility, including a condemnation of 
 sanitary conditions associated with outbreaks of 
 scarlet and enteric fever at Matanzas, and an outline 
 
324 HEALTH AND EMPIRE 
 
 of the problem with which the city is confronted in 
 seeking to remedy this evil. It is surprising to read 
 that the water-rent is so high at fourteen dollars, or 
 sixty shillings, per month that it is impracticable 
 to forbid the poorer classes the use of contaminated 
 water from the city wells. From Germany not 
 only the weekly death-rate of Berlin and other chief 
 cities, and its principal constituents, are given, but 
 also the German report of plague, cholera and small- 
 pox in Egypt, Japan, British South Africa, Brazil 
 and Turkey. From India two pages of figures are 
 given as to the mortality in Bombay city from various 
 causes in previous months and years. A brief 
 statement is also made of health at Calcutta. Re- 
 ports from South and Central America and the 
 West Indies are of course of the greatest importance 
 to the United States ; and so we have detailed ac- 
 counts of the work being carried on against yellow 
 fever and of mortuary records in different parts of 
 Mexico, Nicaragua, Panama and Peru ; while the 
 dangers threatened to the Philippine Islands from 
 cholera, from plague and from smallpox in Hong- 
 Kong and Saigon, are fully described. 
 
 A quotation from this paragraph shows the nature 
 of the information embodied in the bulletin, and its 
 evident advantage to sea-borne commerce : 
 
 " The contagious diseases report of Manila is particularly 
 encouraging at this time, because the quarantinable diseases in 
 the near-by foreign countries have been decidedly on the increase. 
 At Hong-Kong alone ninety-nine cases of plague were reported for 
 the two weeks ended June 25th ; at Amoy plague is reported to be 
 increasing very rapidly ; at Saigon the cholera situation remains 
 
FEDERAL HYGIENE IN THE STATES 325 
 
 unchanged. The French bills of health report cholera as being 
 present in the interior, but information obtained from ship 
 captains is to the effect that the disease is also present in the port 
 of Saigon. The masters of vessels plying between this port and 
 Saigon have shown a great willingness to aid in preventing the 
 introduction of cholera from that port. So far as it has been 
 possible to ascertain they have faithfully carried out the sugges- 
 tions that none of their crews be permitted to go ashore, to take 
 aboard no fresh vegetables, and not to take any water at Saigon 
 if it can possibly be avoided. In view of the fact that there are 
 no available data upon the wholesomeness of the Saigon water, 
 every ship that arrives here from that port carrying Saigon 
 water is required to discharge the same before entering the 
 harbour, and the tanks are disinfected with permanganate of 
 potassium." 
 
 Thus it may be seen that merchants shipping 
 goods to the Philippines on 20th August were able 
 at least to know the condition of affairs in Manila 
 and the ports connected with Manila two months 
 previously ; those shipping goods to Hong-Kong 
 or Amoy would know the danger they ran of being 
 quarantined afterwards at any other port at which 
 they might call, on account of plague ; and those 
 shipping goods to Saigon would know that there was 
 a considerable possibility of their ships' crews being 
 attacked and decimated by cholera and their cargoes 
 destroyed. The commercial value of this informa- 
 tion is undoubtedly of the first importance. 
 
 Further evidence is given of this care of the federal 
 government for their citizens trafficking abroad by a 
 circular quoted in the bulletin, signed by an assistant 
 surgeon in the marine hospital service, approved by 
 the United States consul and the consul of Panama, 
 and headed, " Callao, Peru. To Steamship Com- 
 
326 HEALTH AND EMPIRE 
 
 panics, Agents, Masters, Physicians of Merchant 
 Vessels, and Others concerned." This circular draws 
 attention in detail to the " requirements of the 
 United States quarantine regulations, which are 
 to be observed at this port by vessels bound for 
 ports in the United States and the republic of 
 Panama." 
 
 A brief account follows at random of yearly and 
 monthly statistical reports of mortality from various 
 cities and countries all over the world England 
 and Wales, Lourenco Marques, Batavia, Nagasaki, 
 Georgetown (Demerara), Barcelona and Gibraltar. 
 Last of all, reports received from United States 
 consuls through the department of state and from 
 other sources as to cholera, yellow fever, plague and 
 smallpox, the four most dreaded human scourges 
 of the tropics, are given as fully as is possible under 
 the circumstances. 
 
 The information given in this bulletin is partial 
 in the extreme, and it is at least one if not two months 
 out of date by the time it is published ; but that it 
 forms the nucleus of information which might be of 
 the greatest value to the shipping world is beyond 
 question. For British purpose it may well be sug- 
 gested that an essential undertaking of our Board of 
 Trade or of any department that may be constituted 
 for imperial government should be to institute a 
 system of health-intelligence, to collect information 
 with the help of the colonial, foreign, India and war 
 offices, of the local government board and of the 
 admiralty, to estimate its value and to publish the 
 results in the most convenient form and with the 
 
FEDERAL HYGIENE IN THE STATES 327 
 
 least possible delay for the use of the mercantile 
 community. 
 
 The precedent has only been established this year 
 in the weekly publication by our local government 
 board of the returns of notifiable disease in the United 
 Kingdom. This requires extension to ports and 
 countries overseas. At present, but only when 
 attention has been drawn to certain conditions 
 demanding notice, such as the prevalence of plague 
 in India, South Africa, or Hong-Kong, official state- 
 ments appear to be cabled home weekly and issued 
 to the Press. This system of casual information 
 should be replaced by a weekly system of notification 
 of all infectious diseases of importance to commerce, 
 from every port and chief city, not only in our own 
 empire but throughout the world, where there may 
 be a British consul, a ship, a resident, or an official 
 representative of any sort. These reports, received 
 by wire during the slack hours of the week-end, should 
 be published in bulletin form, resembling that issued 
 by the public health and marine hospital service of 
 the United States, on every Monday evening. By 
 Tuesday, in that case, every British shipowner would 
 know the epidemic dangers to which his business is 
 subjected, as judged by a report only three days' old. 
 
 Is it worth while ? Official experience teaches 
 early that the worth of any proposal in this world 
 must be measured by finance. If the government 
 were to produce regularly, with the high authority 
 that it could command, a bulletin of such value as 
 this to the commercial world, the commercial world 
 would probably be glad to repay it. 
 
328 HEALTH AND EMPIRE 
 
 It is difficult, without the advice of an inter-depart- 
 mental committee, to estimate what the cost of such 
 a bulletin would be. But the personnel required 
 for the purpose is already to hand ; the advantage 
 would be like that of starting a newspaper with your 
 correspondents already paid by other concerns and 
 your plant established and kept going on a large 
 scale by your other businesses. The cost of pro- 
 duction would amount to little more than the cost 
 of the telegrams at government rates and of an expert, 
 with clerical help to deal with them. The bulletin, 
 indeed, by the inclusion of advertisements, might 
 become a most paying concern ; but that is one of the 
 economies which it would seem futile to impress 
 upon government, for reasons which they have 
 doubtless often and fully considered. 
 
 It has seemed advisable to suggest a commercial 
 ground for supporting the proposal of a weekly im- 
 perial bulletin of health, because neither our govern- 
 ment nor the general public, nor even the commercial 
 men themselves, have yet recognised, as is recognised 
 in Germany and America to a considerable degree, 
 the immediate pecuniary value of science to the con- 
 cerns in which they are interested. If any proposal 
 affect trade affect trade, that is, directly they are 
 at once all ears to hear of it. If it affect trade only in- 
 directly through scientific research, they want to be 
 shown definitely and clearly how such scientific 
 measures are likely to benefit trade. If research be 
 merely proposed in the general hope that it may lead 
 to the advancement of knowledge in the sciences on 
 which trade transactions are based, then they consign 
 
FEDERAL HYGIENE IN THE STATES 329 
 
 it at once to the tender care or eternal oblivion of 
 private charity. 
 
 But, to those who have eyes to see, it will be obvi- 
 ous that here in the British Empire, here in London in 
 the departments of government which supervise the 
 all-pervading trade of our race, we have to our hand 
 an agency which can present us with the most com- 
 plete and regular statistical basis of the science on 
 which rests the prevention of disease. As we of the 
 health-service believe that to prevent disease is a task 
 more honourable although less honoured than to cure 
 it ; as we know that the prevention of disease depends 
 to a large extent, especially in warm climates, on the 
 prevention of infectious disease spreading in epidemics 
 throughout the world ; so must we consider it of the 
 first importance that we should know authoritatively 
 and at regular periods the strength, distribution and 
 movements of these plagues, in relation to the varied 
 conditions of climate, habit and race in different parts 
 of the world. Until that knowledge is at hand we 
 are at a manifest disadvantage in considering their 
 life history and in devising means to exterminate 
 them and prevent their recurrence. 
 
 This task may eventually be undertaken by the 
 international bureau of hygiene at Paris. But there 
 are difficulties in the way of international action in 
 such a matter ; and the result, if more comprehensive, 
 would be less detailed. Nationalism is a stronger force 
 than internationalism ; and reports from British re- 
 presentatives only would be standardised and of 
 greater value. For the present therefore, at least, it 
 is best to propose a report on a British official basis. 
 
330 HEALTH AND EMPIRE 
 
 It may be hoped that the result of such a proposal 
 will not stop at reports by correspondence. A system 
 thus initiated would lead naturally to the employ- 
 ment of many highly- trained experts, whose large 
 practical experience in various parts of the world and 
 in various services is at present wasted in retirement, 
 for further service in investigating, reporting and 
 advising on such health-problems of different parts of 
 the Empire as require consideration by other than the 
 experts and permanent staff of the locality. It would 
 co-ordinate the work hitherto undertaken by missions 
 from the Liverpool and London schools of tropical 
 medicine, by royal commissions, by experts casually 
 employed by the colonial and foreign offices. It 
 would lead to the creation of an Imperial General 
 Staff to conceive and advise as to the execution of 
 plans, on imperial lines and by general co-operation, 
 for the arrest and prevention of pestilence and the 
 promotion of health in every part. 
 
 As the basis of this organisation and as the neces- 
 sary equipment for the campaign which it is the proud 
 duty of health officers to wage against disease in 
 every shore and sea, I ask for the weekly publication 
 of the latest and fullest possible returns of epidemic 
 disease from every place in which the British govern- 
 ment is represented throughout the whole world. 
 
CHAPTER XVII 
 
 MR. CHAMBERLAIN'S SPEECHES ON THE POLICY OF 
 HEALTH AND EMPIRE 
 
 THE credit is due to Mr. Chamberlain of having been 
 the first minister of the crown to realise and formu- 
 late the value of health to our imperial power ; and 
 to adopt the duty of attention to the public health 
 as an axiom of our imperial rule. 
 
 His attention was first drawn to the subject in 
 connection with the health of the administrative 
 staff of our imperial colonies. Appointed colonial 
 secretary in 1895, he had already succeeded in 
 securing the establishment of the London School of 
 Tropical Medicine, as the first step in a practical 
 policy for discovering and removing the cause of 
 tropical diseases, when on the loth May, 1899, ne 
 presided at a festival dinner of the Seamen's Hospital 
 Society and appealed for funds for the school and for 
 the enlargement of the branch hospital in the docks 
 to fifty beds. The House of Commons had voted 
 3500 for this object and promised 1000 a year 
 for its maintenance. Lord Lansdowne, as secretary 
 of state for war, said that of all the enemies the 
 British soldier had to encounter, tropical diseases 
 were the most formidable. 
 
 ' We are met here to-night/ said Mr. Chamberlain, 
 331 
 
332 HEALTH AND EMPIRE 
 
 * to promote Imperial Policy. The British Empire 
 contains, I suppose roughly, something like 
 300 millions of coloured people, living mostly in 
 tropical climates, and it is the government and 
 control of the tropics which form the principal part of 
 that " white man's burden," the immensity of which 
 has caused some of our statesmen to regard the future 
 with anxiety akin to fear. The other day Mr. 
 Rhodes in a speech referred to a conversation that 
 he had had with Mr. Gladstone, in which that great 
 minister had said that he was afraid lest the number 
 of men qualified for colonial administration should 
 be insufficient for the work which an extended empire 
 involved. For myself I agree with the reply which 
 was made by Mr. Rhodes. I believe so long as the 
 British character remains unchanged, the opportuni- 
 ties of distinction, the prospect of adventure, and 
 the love of responsibility which is deep-seated in our 
 character will always prove a sufficient temptation 
 to secure that the supply shall be equal to the de- 
 mand. But, my lords and gentlemen, that does not 
 relieve us from the obligation to see that every pre- 
 caution is taken and every effort made to prevent 
 this splendid material, those potent instruments of 
 our greatness, those props of our empire, from being 
 wasted and thrown away owing to the neglect of 
 precautions, which, if they were properly fulfilled, 
 might save their lives or extend their usefulness. 
 
 ' It is impossible for anyone, who occupies the 
 position which I have the honour to fill, not to be 
 painfully impressed with the tragedy which is always 
 being enacted, that of the mortality which cuts off 
 
MR. CHAMBERLAIN'S SPEECHES 333 
 
 young men of great promise in the very outset of 
 their career, which strikes down in their prime ex- 
 perienced administrators and able and conscientious 
 officials, which, even though it is not vital to indi- 
 viduals, at all events weakens the service by constant 
 illness, disorganises the administration and prevents 
 anything like continuity of policy owing to the fre- 
 quent breaks which are necessary in order that im- 
 paired health and strength may be restored/ 
 
 The policy proposed then should consist of (i) 
 training medical practitioners for the tropics to 
 investigate the cause and cure of disease ; (2) in- 
 structing all who go to the tropics in the rules of 
 health ; (3) providing the best medical and nursing 
 attendance on the sick. Mr. Chamberlain referred 
 to the Colonial Nursing Association, to the work done 
 in Italy and by Dr. Ross in India as to malaria, to the 
 investigation about to be undertaken in Italy and in 
 Central and West Africa by the Royal Society on 
 malarial and blackwater fevers, to the Colonial Office 
 circular to the schools of medicine, asking them to 
 give their students some special training in tropical 
 diseases. But these measures would be incomplete 
 without a school devoted to tropical medicine, and 
 for that he made an eloquent appeal for funds. 
 
 ' I think I am not too sanguine when I say that we 
 have a right to expect a bountiful and beneficial 
 harvest. Why should we despair ? Is it too much 
 to ask of science that it should confer this great 
 benefit upon mankind ? When I look at what has 
 been done in the past by the efforts of science, the 
 plagues of the Middle Ages which devastated vast 
 
334 HEALTH AND EMPIRE 
 
 districts and which have now ceased out of the land, 
 at the fact that within our own time cholera and 
 typhus have lost most of their terrors ; when I 
 remember what we have been told by Sir A. Hoskins 
 and how in the West Indies the frequency and virul- 
 ence of the epidemics of yellow fever have been 
 greatly diminished ; when I know that colonies like 
 Hong-Kong, cities like Calcutta, which during the 
 present century earned the evil reputation of being 
 a white man's grave, have now become comparatively 
 safe, I say there is no reason to despair that science 
 may yet do something to lessen the unhealthiness of 
 other settlements, more especially of those in Africa, 
 thus removing the greatest hindrance to the develop- 
 ment of that vast continent. 
 
 ' My lords and gentlemen, the man who shall 
 successfully grapple with this foe of humanity and 
 find the cure of malaria, for the fevers desolating our 
 colonies and dependencies in many tropical countries 
 and shall make the tropics liveable for white men, 
 who shall reduce the risk of disease to something 
 like an average will do more for the world, more for 
 the British Empire, than the man who adds a new 
 province to the wide dominions of the Queen. And 
 those who co-operate in securing this result, whether 
 by personal service or by some pecuniary sacrifice 
 will be entitled to share the honour and to add their 
 names to the greatest record of the benefactors of 
 mankind.' 
 
 On the 25th of July of the same year Mr. Chamber- 
 lain and Mr. Asquith spoke at the Annual Meeting of 
 the Colonial Nursing Association at Stafford House. 
 
MR. CHAMBERLAIN'S SPEECHES 335 
 
 Founded in 1896 by Mrs. Piggott of Mauritius, this 
 body has now sent 258 nurses abroad and finds the 
 a e 35 to 50 best. It was only appealing for 
 a modest endowment of 5000. Mr. Chamberlain 
 testified to the advantages derived by tropical 
 colonies from the services of the Colonial Nurses. A 
 letter from Col. Willcocks on the Niger River declared 
 that the recovery of some of his young officers from 
 blackwater fever was due to the attention and care 
 of these nurses. ' It is a mission to all those who are 
 interested in the development of the great empire 
 of which we form a part. Lives such as these, so 
 precious to the empire, the lives of those who are 
 the successors of those who gained the empire for 
 us, such lives ought not to be wasted. We owe it to 
 them and to ourselves to do all in our power to pre- 
 serve them, and to see, so far at all events as that 
 may be possible, that when they are struck down, as 
 unfortunately they often are in the course of their 
 duty, by illness, at all events they shall not want the 
 tending of skilful and kindly hands, and that sym- 
 pathy, that womanly attention, which will be found 
 to be the best anodyne for their pain and perhaps the 
 most effective cure for their disease.' 
 
 On the i5th March, 1901, a deputation went to the 
 Colonial Office representing the London, Liverpool 
 and Manchester Chambers of Commerce and the 
 Liverpool School of Tropical Medicine, to present a 
 statement which proposed : 
 
 " (i) That the governments of the various colonies 
 on the west coast of Africa be invited to pre- 
 
336 HEALTH AND EMPIRE 
 
 pare schemes, with estimates, for the complete 
 organisation of sanitation in the coast ports 
 in the vicinity of quarters permanently occu- 
 pied by any considerable number of Europeans, 
 especially with regard to 
 
 " (a) removal and disposal of refuse ; 
 
 " (b) complete surface drainage of the soil 
 
 and removal of bush and undergrowth ; 
 " (c) removal of native huts where their pre- 
 sence is a menace to the health of 
 Europeans ; 
 
 " (d) institution of sanitary regulations for 
 observance by the public within the 
 areas indicated above. 
 
 " (2) That at the same time a sanitary com- 
 missioner, or sanitary commissioners, be 
 appointed by the colonial office to visit 
 repeatedly all the said colonies, and to re- 
 port to the secretary of state the condition of 
 sanitation in each colony, and the steps being 
 taken to improve it by the local authorities. 
 " (3) That where new settlements are being 
 planned, quarters for Europeans shall be 
 arranged as far as possible on the Indian 
 cantonment model, and that special regula- 
 tions shall be made to prevent the over- 
 crowding of such cantonments by the general 
 public." 
 
 In reply Mr. Chamberlain, in disagreement with 
 some of his predecessors in office, expressed his 
 belief in the future of West Africa, and addressed 
 
MR. CHAMBERLAIN'S SPEECHES 337 
 
 himself to the proposition that health was a financial 
 asset, which justified expenditure on its preserva- 
 tion. After noting the influence on morality of the 
 unhealthy and lonely conditions of life in many 
 tropical posts, he referred to the importance he had 
 found attached to this subject by every colonial 
 governor that had returned home from the coast 
 since he had been at the Colonial Office. He differed 
 from the deputation by showing that more was being 
 done in this direction than was realised, and, in 
 pointing out the limits of expenditure justifiable on 
 sanitary inspection, said : 
 
 Sanitary inspection was carried on in this country 
 (England) under circumstances to which the Gold 
 Coast presented no parallel. Arrangements here 
 could be made without difficulty which could not be 
 made in a new and tropical colony. Even here they 
 sometimes complained of being a little overburdened 
 by inspectors, and said that a counsel of perfection 
 was sometimes put before them which was not really 
 possible of attainment. If they were to have a 
 house-to-house inspection in those colonies on the 
 West Coast, of natives as well as of Europeans, and 
 inspectors in turn were to be themselves inspected 
 by a superior officer with all the scientific require- 
 ments which were necessary, and if, again, those 
 inspectors were to be supervised by travelling 
 inspectors sent over from this country, he confessed 
 that he trembled at the budget which would be pro- 
 duced, and there might be a reaction in consequence 
 of attempting too much. No doubt the matters to 
 which his attention was called deserved and required 
 
338 HEALTH AND EMPIRE 
 
 urgent attention. But schemes for which they asked 
 were already in preparation, and in some cases had 
 been prepared. The water-supply was undoubtedly 
 of first-rate importance, but also, unfortunately, it 
 involved a very heavy expenditure. The question of 
 sewage disposal was another question, the difficulty 
 and magnitude of which everybody who was con- 
 nected with the government of a big town must be 
 fully aware of. But, still, all these points had been 
 and were receiving the careful consideration of the 
 Government, and he trusted that they might be 
 able to do something in connection with them. A 
 great deal had been said, with reason, as to the 
 danger caused by the too close proximity of the 
 European residences to the residences of the native 
 population. In Accra that matter had been to a 
 great extent dealt with, and the dwellings of the 
 Europeans had been moved away from those of the 
 native population. In Sekondi, which was going to 
 be a considerable place, owing to the establishment 
 of the railway, which if continued to Kumasi would 
 be of great importance, Major Maitland had already 
 acquired a very considerable portion of land, with the 
 object of building upon that land, separately and 
 away from any native population, the buildings 
 required for any Europeans. In other places the 
 same sort of precautions were already being taken. 
 He had great hopes as a result of the great railway 
 work which was now going on, of which about 400 
 miles had been made in the West Coast colonies 
 during the five years he had been in office. The 
 general effect on commerce and trade of this had 
 
MR. CHAMBERLAIN'S SPEECHES 339 
 
 a very definite bearing upon the question they were 
 now discussing, because if they could have railways 
 running into the interior and a more elevated country 
 it would not be impossible to establish in all the 
 colonies sanitary places, to which at all events a 
 considerable amount of the administrative work of the 
 colonies might be moved and with it a considerable 
 portion of the European population. Of course the 
 coast ports must always have a European population 
 dealing with the Customs and the large export and 
 import trade. Even with that population, if the 
 railways were sufficient, and if, as he hoped, they 
 were very greatly and very quickly extended, even 
 that population might be carried out of the town at 
 short intervals, perhaps every day, certainly every 
 week, and they might enjoy at intervals the fresh 
 air and better conditions which he hoped would have 
 a very considerable effect upon their health. 
 
 He suggested therefore the appointment of a small 
 sanitary commission to consist of three members 
 of the chambers of commerce, with a sanitary ex- 
 pert and a representative of the Colonial Office. 
 
 He should refer to them also the question of how 
 the funds were to be provided. He would ask them to 
 estimate the cost in each colony and to report to him 
 how the money required to carry it through could be 
 provided with the least inconvenience to those con- 
 cerned. He was glad to see in the memorandum 
 of the Manchester Chamber a statement to the effect 
 that they were not unwilling that a sanitation rate 
 should be levied, either in the form of an additional 
 import duty or some form of local taxation, the 
 
340 
 
 money raised to be devoted solely to the improve- 
 ment of the health of the colonies. That would be 
 a matter for this Commission to consider. But the 
 Manchester Chamber went on to say that they would 
 like to draw attention to the enormous increase there 
 had been in expenditure in recent years and re- 
 commended that it should be raised by economy in 
 other directions rather than by increase of taxation. 
 If it could be found by economy rather than by 
 increased taxation, they all agreed that that would 
 be a far preferable method. To this same Com- 
 mission he would refer this branch of the Inquiry 
 and if they could recommend economy which could 
 be carried out without injury to the administration 
 or to the security of those colonies he would be only 
 too glad to consider it favourably. 
 
 On 3oth June, 1904, a banquet was given to Mr. 
 Chamberlain by the Royal Institute of Public 
 Health, " in recognition of his services to preventive 
 and tropical medicine whilst filling the office of 
 Colonial Secretary, 1895-1903." The large and dis- 
 tinguished assembly present in his honour included 
 Mr. Lyttleton, Lord Onslow and Mr. Balfour. In 
 proposing his health, the President of the Institute 
 referred to the municipal undertakings of Birming- 
 ham, for which Mr. Chamberlain was in large part due, 
 and showed his exceptional activity in promoting 
 health in the tropics. 
 
 Mr. Chamberlain in his reply disclaimed excep- 
 tional credit for his action. ' I claim no more than 
 may be usually claimed by every other statesman, 
 by everyone who is interested either in social reform 
 
MR. CHAMBERLAIN'S SPEECHES 841 
 
 or in colonial development that is the interest which 
 we all take in the work of medical research and 
 preventive medicine, and the expectation we enter- 
 tain of the great results which may be expected from 
 them/ 
 
 He spoke of diphtheria antitoxin and the advances 
 made in curative medicine. ' But, while we look 
 with confidence to the further results of curative 
 medicine, I think we shall all be agreed that pre- 
 ventive medicine is better still. Now, at any rate, 
 the importance of securing healthy conditions of 
 life is recognised by everybody who cares for the 
 welfare of his fellow-creatures. I recollect very well 
 the speech which was made, I think in the early 
 seventies, by Mr. Disraeli, and which was at that 
 time the subject of some ridicule from myself and 
 others, in which he spoke of the importance of 
 sanitary reform as the foundation of every other re- 
 form. None of us are likely to ridicule such a state- 
 ment now. Now we feel that sanitary reform is not 
 unworthy of the attention of the highest statesman- 
 ship. Now we recognise that without it social re- 
 form is an empty phrase. The housing of the poor, 
 the attempt to prevent the physical deterioration 
 of the race, and all other matters to which we 
 legislators devote such part of our time and attention 
 as we can spare from party conflict, all these things 
 depend, are founded upon, sanitary reform. Pre- 
 ventable disease, at this moment, is, as we all know, 
 a great agent for filling our workhouses, for raising 
 our taxes, for weakening the fibre of the people, for 
 preventing us from competing successfully in that 
 
342 HEALTH AND EMPIRE 
 
 eternal struggle for existence which must go on as 
 long as the world shall last. In peace it is of the 
 utmost importance ; in war the same cause destroys 
 more of our soldiers than the bullets or the swords 
 of the enemy, and meanwhile the administration of 
 the army is lessened in efficiency by preventable 
 disease to which the agents of the Empire are 
 constantly subject. And, Mr. President, I may be 
 excused in regard to my experience if I say that it 
 is this branch of preventive medicine which at the 
 present time enlists my warmest sympathies. 
 
 ' For, after all, I repeat what I have said on other 
 occasions. The work of this century, or at all 
 events, of the beginning of the century upon which 
 we have entered, is the consolidation of our Empire. 
 And this is one branch of the greatest of all subjects ; 
 how are we to fulfil the task which Providence has 
 laid upon our shoulders, a greater task than has 
 ever been imposed upon any other nation, a task 
 which we are now fulfilling not without success, but 
 the greatness, the increasing greatness of which may 
 well fill even the boldest of us with some anxiety.' 
 
 The work of our countrymen in the colonies was 
 then described, both in peace and war and in the 
 prevention of war and slavery. ' These men are the 
 greatest assets of the Empire. Let us prize them and 
 value them, let us do everything to keep them in the 
 vigour of life ; and it is for that reason that I attach 
 so much importance to these investigations, to those 
 studies, to this research, which is going, I verily 
 believe, sanguine optimist as I always am in the 
 course of time to make these tropical climates, which 
 
MR. CHAMBERLAIN'S SPEECHES 343 
 
 have been each in their turn the white man's grave, 
 to make them places where white men can live in 
 comfort. It is because of this that I wish to conclude 
 by saying that, after all, one of these almost un- 
 known students working in laboratories in London, 
 Liverpool and elsewhere may be doing more good 
 for the Empire than any statesman has been able 
 to do, however high his position. It is with that 
 feeling that I have had so much pleasure in attending 
 this meeting, and it is with that feeling that I thank 
 you one and all most heartily for that sympathy 
 which you have shown, I will not say with perform- 
 ance, but at all events with intention, to that ideal 
 which I hope every patriotic Englishman sets before 
 himself.' 
 
 Mr. Balfour, in replying to the toast of " Preventive 
 Medicine and the State," epitomised the duties of 
 the state in this regard, as involving, firstly, the 
 internal problem of maintaining, despite increas- 
 ing urbanisation, ' the inevitable physical basis of 
 every great national and imperial aspiration ' ; and, 
 secondly, the external problem of turning the ex- 
 traordinary natural resources of the tropics to the 
 best account. It was in this respect, as well as in 
 the other more public spheres of his official work, 
 that Mr. Chamberlain would be reckoned on all sides 
 as the greatest colonial minister the country had seen. 
 ' Turn our great tropical colonies into places where 
 the white man could live in reasonable health and 
 comfort, and they would add, directly and in- 
 directly, incalculable gains to the commercial future 
 and industrial prosperity of this country.' 
 
344 HEALTH AND EMPIRE 
 
 On the I2th January, 1905, Mr. Chamberlain at- 
 tended a lecture by Major Ronald Ross in Liverpool 
 on " The Progress of Tropical Medicine." In an 
 informal speech Mr. Chamberlain let fall a definition 
 of our colonial policy. ' I remember on one occasion 
 a foreign monarch said to me, " Of all the things 
 in connection with your British history, the one I 
 admire most is your colonial policy." I said to him, 
 " Sir, I think you do us too much honour. We have 
 never had a colonial policy, but somehow or other, 
 we have been allowed to blunder into the best parts 
 of the world." ' 
 
 And again he gave his tribute, as of personal 
 obligation, to the imperial workers in the tropics, 
 emphasising the debt due to those who by research 
 or by practice help to prevent tropical disease and 
 so bear their share in the foundation of the Empire. 
 
 The last public speech on this subject was made by 
 Mr. Chamberlain in again presiding over a dinner in 
 aid of the London School of Tropical Medicine, on 
 the nth May, 1905. He came back to them, he said, 
 to rejoice in the past success and to provide for their 
 future. His interest in that question was unex- 
 hausted, indeed unabated. This duty had increased 
 in recent years with the continual extension of our 
 territory, with the increase of our scientific know- 
 ledge and our opportunity and also with the awaken- 
 ing of our imperial conscience. We owed this duty 
 to the vast population for which we had gradually 
 made ourselves responsible. He praised the gener- 
 osity of Liverpool in providing 40,000 for their 
 school of tropical medicine ; recalled the services 
 
MR. CHAMBERLAIN'S SPEECHES 345 
 
 of the 503 students, officials, traders and missionaries 
 who had even then passed through the London 
 school ; deplored their difficulties in raising, even 
 with much assistance from the government and the 
 empire, 30,000 in a city so dependent as London on 
 tropical development, and he appealed for 100,000. 
 
 There could not be a more desirable application of 
 superfluous wealth than to enable that institution 
 to unite the work of the investigator and the work of 
 the physician, which was after all the ideal union 
 between scientific inquiry and its practical applica- 
 tion. He asked them to sympathise with those 
 workers of our empire who had already done so much 
 to secure its renown, and who had contributed, and 
 were contributing, to the happiness and welfare of 
 the vast populations which we had gathered together 
 under the protecting influence of a single flag. 
 
 It will be noticed that Mr. Chamberlain's advocacy 
 of health as of imperial importance concerned itself 
 mainly with the health of the white men, especially 
 the administrators, in the tropics. That is only a 
 small part of the problem considered throughout this 
 book, which seeks to show the value of health in 
 the rank and file, not merely in the officers' mess. 
 His appreciation of this more general proposition as 
 the basis of social reform is indeed shown by Mr. 
 Chamberlain in practice as Mayor of Birmingham and 
 in principle in the speech to the Royal Institute of 
 Health, already quoted (p. 341). But in office the 
 keen business eye, selecting the more pressing and 
 more obvious needs of colonial administration, fixed 
 on the most vulnerable point and attacked it with 
 
346 HEALTH AND EMPIRE 
 
 a will, being assured of public sympathy for those 
 who sacrifice their lives or health in carrying out a 
 recognised imperial duty. Secure the health of the 
 white man, and from the same source, if not from the 
 same measures, the health of the masses will follow. 
 Secure the health of the tropical dependencies ; the 
 white men need less reminder of the need of health- 
 measures in their respective homelands. 
 
 Thus did Mr. Chamberlain lay the foundation-stone 
 of a policy of health and empire, and start a tra- 
 dition on which his successors have built and will 
 doubtless build in future. It is the object of this 
 book to promote this policy, and in doing so it has 
 seemed well to recall the pioneer part played in this 
 movement by Mr. Chamberlain. 
 
CHAPTER XVIII 
 HEALTH AND THE BRITISH EMPIRE 
 
 THE PRACTICAL CONCLUSION 
 
 " It seems to me best to approach the prevention of disease, not 
 so much from its humanitarian as from the economic point 
 of view. Disease always causes a large expenditure of 
 money . . . and mosquito-borne disease is especially a 
 source of such expense. . . . The prevention of disease 
 should be looked on economically as insurance against the 
 useless expenditure caused by such maladies." Professor 
 RONALD Ross, in Report of the Advisory Committee for the 
 Tropical Diseases Research Fund for 1910, Appendix I., p. 21. 
 
 IT is hardly too much to claim that Professor 
 Ross by his proof, obtained by incredible labours 
 in India under the most trying and discouraging 
 conditions, that malarial infection was invariably 
 conveyed by the mosquito, is thereby, with Pasteur 
 and Lord Lister, the greatest preserver of human life 
 and deliverer from sickness yet given or likely to be 
 given to the world, and that he has thereby done more 
 than any soldier, trader, explorer or politician to 
 strengthen the British Empire. It is therefore of 
 importance to note his emphasis on the financial 
 rather than the humanitarian aspect of national and 
 imperial health. It is not so much that philanthropy 
 is of minor importance as that finance is the medium 
 
 347 
 
348 HEALTH AND EMPIRE 
 
 in which the whole business of the world is transacted. 
 What does it cost, what does it save in cash as 
 representing so much thought and will-power, labour 
 and raw material ? That is the problem directly or 
 indirectly in every proposal, worldly or other-worldly, 
 that presents itself to the efficient man. The outcry 
 of certain pseudo-philanthropists against money- 
 making is due either to shallow thought or slipshod 
 expression. The objection should be to faulty 
 money-spending. 
 
 It has been the aim of this book, as of the travels 
 on which it was based, to prove that health was a 
 matter of business efficiency in imperial welfare. 
 It is also, as in the case of Indian plague, a matter of 
 humanity ; and on that score may attract occasional 
 and ephemeral attention. But governments and 
 the public take a purely fatalistic and careless view 
 of it. A despatch to the Indian government, a 
 circular to overworked district commissioners, a 
 report as to the need of economy and the matter 
 drops. The local administrators know it is only a 
 matter of philanthropy ; agriculture, police, education 
 on western lines are solid business, and it is on these 
 they will be judged. 
 
 Granted, however, that we are learning to recognise 
 the solid money-making worth of every healthy 
 citizen, that we are learning in civil life the hard 
 lessons learnt by the army that medical work on 
 preventive and strengthening lines is essential to 
 the working, fighting strength, let us consider in 
 conclusion the practical steps available to secure 
 the utmost physical efficiency and therefore wel- 
 
HEALTH AND THE BRITISH EMPIRE 349 
 
 fare for the 400,000,000 inhabitants of the British 
 Empire. 
 
 THE NEED OF COMMON ACTION 
 
 Of all departments of national life, none more 
 urgently requires the widest possible field of study 
 and action than that of health. Health depends on 
 the relation of the human frame to its environment, 
 animate and inanimate. It is essential to discover 
 the limits of this relationship before we can under- 
 stand the cause of its disturbance. It is absurd 
 to confine our study of health and disease to a single 
 race, living in fixed conditions in an equable climate. 
 Experiment on the human body is subject to natural 
 restrictions ; experience under the widest possible 
 range of circumstance throws a wider light on its 
 capabilities. 
 
 Study of health and disease, therefore, should 
 extend to the whole animal and vegetable creation ; 
 should extend to all races of mankind in every 
 climate and condition of life. Manson's study of 
 elephantiasis, Ross's study of malaria, have turned 
 attention at home to the part played by flies, fleas, 
 ticks and other insects in the spread of the commoner 
 infectious diseases. The result is already seen in the 
 extraordinary diminution of infantile diarrhoea and 
 mortality in the last few years. It is the unfortunate 
 heritage, not the fault, of the medical schools that 
 they show an utter lack of appreciation of these 
 possibilities and of the need of this wider view. 
 Tropical disease, botanical and veterinary pathology, 
 
350 HEALTH AND EMPIRE 
 
 are to them things apart ; their study and teaching 
 of medical science is limited to the narrow groove of 
 curative medicine as applied to man, the Englishman, 
 in England; and few of their pupils can realise the 
 full scope of health and disease until their subsequent 
 duties in life bring them in touch with different condi- 
 tions to those seen at a general hospital in these isles. 
 
 It is of importance therefore to co-ordinate the 
 experience of health and disease in each category of 
 life, in every part of the world. It is on these lines 
 that M. Jacques Cazotte conducts the International 
 Bureau of Hygiene in Paris. But international 
 systems and inquiries have limitations of another 
 order ; they lose in driving-power and in co-ordina- 
 tion more than they gain in breadth, at least as 
 compared with the possibilities of similar under- 
 takings throughout the British Empire. Some na- 
 tions hide awkward facts ; others deliberately lie ; 
 we alone adopt the policy of declaring the whole 
 truth, and if our news be false the ambassador con- 
 cerned makes immediate inquiries. But the diversity 
 of race and climate, which our empire affords, and of 
 every condition compatible with life, offers a com- 
 plete field of study, complete enough at least for the 
 present, in this regard. 
 
 The aim too of international effort, as of pure 
 science, is too remote from daily life to attract the 
 co-operation of the inexpert. Nationalism is a 
 growing, not a dying, force ; it is a most effective 
 handle to the machinery of life. As charity must 
 begin at home, so should research and defence of 
 life begin with the most concise unit capable of 
 
HEALTH AND THE BRITISH EMPIRE 351 
 
 supplying the necessary factors ; and that is, for 
 British sanitarians, the British Empire. 
 
 The assistance of the inexpert but intelligent 
 layman is indispensable. The expert is indeed the 
 keystone of the arch ; but the arch consists and is 
 founded on the common life. Both in administra- 
 tion and also in the observation and reporting of 
 facts, which constitute the most important ground- 
 work of sanitary discovery, health-officers must 
 work through their colleagues in general medical 
 practice ; and doctors all must work through the 
 individuals they serve. As health in the school 
 depends in the end on the teacher, health in the army 
 on the company officer, so health and its investiga- 
 tion in the community must depend on those re- 
 sponsible in various degrees for the daily life and 
 work of the community. 
 
 The basis required for effective development of 
 the imperial health is a co-ordination of the forces 
 that influence the health and disease of all classes 
 and races under the rule of King George. 
 
 INTELLIGENCE 
 
 The first requirement in morbid, as in military, 
 warfare is a proper system of intelligence. Intelli- 
 gence there is in abundance ; blue-books without 
 end ; reports from every microscopic unit of British 
 government when required by some inquisitive 
 parliamentary elector " papers " and figures from 
 every port, city and village that sings " God Save the 
 King." It is the bane of modern government, 
 
352 HEALTH AND EMPIRE 
 
 another misery inflicted by the inventions of the 
 nineteenth century, that superficially accurate figures 
 must be in stock to give to every reader of Tit-Bits 
 a concise statement of every action that passes or 
 should pass under the ken of any representative 
 of the British taxpayer. In the plains of the Punjab 
 one of the best of Indian civilians complained bitterly 
 of the useless office work to which he was condemned, 
 at the expense of the time available for the more 
 primitive and infinitely more satisfactory system, 
 both for rulers and ruled, of touring round his pro- 
 vince and dispensing justice under the village banyan- 
 tree. In every part of official life, a statistical 
 committee should decide what figures were worth 
 collating, what forms should be required to make 
 these figures comparable and of value. The co- 
 ordination of statistics bearing on health and disease 
 throughout the Empire is urgently required. 
 
 The first report on the Census of the British Empire 
 was issued as a three-and-fivepenny blue-book in 
 1906, and^lealt with the figures of 1901. A glance 
 through its sixty-four fascinating pages of letterpress, 
 without reference to its three hundred pages of tables, 
 shows the need, there expressed, for such a regulation 
 of the decennial census. But the regulation must 
 cope with real democratic imperial authority behind 
 it. A decennial census is the basis of vital statistics ; 
 and they again are the groundwork of research and 
 progress in the advancement of the public health. 
 
 The next requisite is an official annual report on 
 the health of the empire. Casual paragraphs in the 
 newspaper, occasional papers in the technical Press, 
 
HEALTH AND THE BRITISH EMPIRE 353 
 
 reports of conferences and notices of epidemics 
 in distant lands are of no permanent value. The 
 public cannot collate them. Even the journals of 
 tropical medicine and hygiene can only devote a 
 small amount of labour and space to the task. As 
 Somerset House has undertaken to produce a decen- 
 nial report on the imperial census ; as the medical 
 officer to the board of education produces an annual 
 report, reviewing the annual reports on school 
 health throughout England and Wales ; as the 
 medical officer to the Local Government Board 
 includes in his annual report some review of the 
 prevalence of epidemic diseases throughout the 
 world ; so should some imperial organisation issue 
 an annual review, in due proportion, of imperial 
 health. 
 
 But annual reports fail to give information of 
 current events while they are still passing. In our 
 sixteenth chapter we have already stated the useful- 
 ness of the weekly bulletin issued by the Marine 
 Hospital Service of the United States and have 
 shown the value of a similar weekly issue for our 
 own empire. 
 
 Port medical officers know the value of such 
 returns in assisting them in their invaluable work 
 of defending their countries against attack from 
 imported disease. The health officer of Shanghai 
 sent me recently copies of weekly returns received 
 by him from the several ports in touch with his own 
 Japan, Hong-Kong, the Philippines, Penang, Calcutta, 
 Colombo and Bombay two or three weeks late. 
 A weekly system of notification and distribution 
 
354 HEALTH AND EMPIRE 
 
 from a single imperial centre by wire would save 
 many an outbreak and much money. 
 
 Any organisation for the collection of such informa- 
 tion would thereby be enabled with the utmost 
 advantage to issue official news to the Press from 
 time to time of disease occurring in the several 
 dominions and possessions ; of research being con- 
 ducted and remedial works undertaken, with their 
 cost and result ; of conferences held, like the imperial 
 malaria conference held at Simla in 1908 ; news 
 which should be invaluable in arousing and main- 
 taining public opinion and of unique importance to 
 the whole tropical world, whereas it is at present 
 bottled up in the official pigeon-holes or rubbish 
 baskets of each separate country. 
 
 A single instance may be given of the need for such 
 mutual information and concerted study. The 
 Times, in its commercial supplement of 2ist January, 
 1907, published an interesting article on " Mining 
 practice ; comparative efficiency of labour on the 
 Rand and in Kalgurli." The prevalence of miners' 
 phthisis in the South African mines is in pitiful 
 contrast with the complete absence of locally-con- 
 tracted cases of phthisis in the Australian. Better 
 ventilation and a less dangerous dust at Kalgurli 
 do not account for the whole difference, the balance 
 of which is attributed to the habits of life on the 
 Rand and the complete change of clothing of every 
 miner on leaving work each day at Kalgurli. Here is 
 a clear case for the exchange of information, dependent 
 at present on a chance article in the Press. 
 
 Such an organisation as is suggested would be 
 
HEALTH AND THE BRITISH EMPIRE 355 
 
 well fitted to issue pamphlets, to employ lecturers 
 and advisers, to make use of various educational 
 methods, which may conduce to a proper understand- 
 ing and improvement of the conditions that make 
 for or against the maintenance of health and strength. 
 It is melancholy to consider that the recent imperial 
 education conference in London did not so much as 
 touch on the questions of physical education and 
 promotion of health. And yet we are officially 
 told that our Board of Education " look upon the 
 work of physical training as a national service from 
 the point of view of education and discipline as well 
 as from that of physique " ; and that the reader of 
 their reports will find " a new understanding of the 
 amplitude, purpose and opportunity of education, 
 a new application of it, fresh fields to be conquered 
 by it." There is, in fact, no co-ordination of in- 
 telligence on matters of imperial health, no organisa- 
 tion prepared and required to take a conspectus 
 of the whole problem and to urge forward to the 
 conquest of these fresh fields. Such an organisation 
 is urgently required. 
 
 AUTHORITIES CONCERNING IMPERIAL HEALTH 
 
 Certain official organisations already in existence 
 pledge the government to an acceptance of the 
 principles here enunciated : 
 
 A. An Advisory Committee for the Tropical Diseases 
 Research Fund was constituted by Mr. Chamberlain 
 as Colonial Secretary in 1904 and issues an annual 
 report on an expenditure of some 5000. In 1910 
 the imperial government contributed 1000, the 
 
356 HEALTH AND EMPIRE 
 
 government of India 500, the dominion govern- 
 ment of Australia 200, and the other governments 
 of other tropical colonies over 1500 between them. 
 Grants were made of about /"aooo each to the schools 
 
 M 
 
 of tropical medicine in London and Liverpool, with 
 lesser sums to the universities of London and Cam- 
 bridge. The last report for 1910 includes much 
 interesting information not only on research but 
 also on the effect of preventive measures in various 
 parts of the world, including a report from Bang- 
 kok by permission of the government of Siam. It is 
 however partial in the extreme and arranged merely 
 as a non-edited series of independent reports. 
 
 B. An Advisory Medical and Sanitary Committee 
 for Tropical Africa advises the Colonial Secretary 
 on medical and sanitary questions connected with 
 tropical Africa. 
 
 C. As a sequel to the international conference 
 of Africa protectorates French, German, Belgian, 
 Portuguese, British held in London in 1907, a 
 Sleeping Sickness Bureau was established, also under 
 the Colonial Office, in 1908. Five out of the seven 
 members, including Sir J. West-Ridgeway as chair- 
 man, are amongst the eleven members of the Tropical 
 Diseases Research Fund Committee. But the 
 Bureau is housed by the Royal Society ; is supported 
 by the Royal Society, by the Uganda protectorate, 
 and, as to one-fourth the cost of upkeep, by the 
 Sudan Government ; and is independently directed 
 by Dr. Bagshawe of the Uganda medical staff. It 
 publishes scientific work for those engaged in research 
 or medical administration, and less technical informa- 
 
HEALTH AND THE BRITISH EMPIRE 357 
 
 tion for the use of lay residents in the African tropics. 
 It is also engaged in mapping out the distribution 
 of the disease and of blood-sucking insects. 
 
 D. As a result of thirteen or fourteen years' 
 continuance of plague in India and the reports of a 
 second Royal Commission, the India Office established 
 an Advisory Board on Plague in India, with its head- 
 quarters at the Lister Institute. This Advisory 
 committee has done admirable work in proving 
 beyond all question the part played by the rat-flea 
 in transmission of bubonic plague. It has not yet 
 thrown much light on the spread of pneumonic 
 plague, and it does not appear to have concerned 
 itself with the practical or administrative problem ; 
 nor indeed was it intended to do so, judging by its 
 constitution and the methods of its work. 
 
 E. Both naval and army medical services have 
 now medical advisory boards, including civilians, 
 whose duties give them information and responsi- 
 bilities with regard to sanitation in most parts of the 
 world. In the composition of these boards, however, 
 there is far too high a proportion of eminent physicians 
 and surgeons who have had but little experience of 
 preventive medicine in relation to the public health. 
 
 F. The Colonial Office is officially advised by Sir 
 Patrick Manson, a pioneer in tropical research and 
 clinical work, although his experience of public health 
 work must necessarily be indirect ; the India Office 
 by Surgeon-General Branfoot, a distinguished re- 
 presentative of the finest all-round medical service in 
 the world ; and the Foreign Office applies to the Local 
 Government Board for advice and often for the loan 
 
358 HEALTH AND EMPIRE 
 
 of a medical officer who will never have lived in 
 the tropics, in connection with the sanitary matters, 
 often requiring foreign travel in tropical regions, with 
 which it has to deal. 
 
 G. The London and Liverpool schools of tropical 
 medicine receive grants for research and the London 
 school is extensively subsidised by the Colonial Office 
 for the specific training of its probationary medical 
 officers. 
 
 There have been many proposals for corresponding 
 imperial action in connection with other departments 
 of government affecting the welfare of the several 
 diminions over the seas, as for instance in the case of 
 colonial agriculture, the complete scheme brought 
 up at the recent imperial conference for a permanent 
 imperial council. The reasons for which the latter 
 scheme was for the present rejected would not how- 
 ever apply to the limited and utilitarian purposes of 
 a health-scheme. As military and naval warfare 
 require the creation of a general staff and a supreme 
 Committee of Imperial Defence, so does the struggle 
 for health require the creation of an imperial advisory 
 council for the promotion of health. 
 
 THE AUTHORITY PROPOSED 
 
 For this purpose then it is suggested that each of 
 the dominion governments should appoint one of their 
 experienced medical officers of health as medical 
 secretary to their high-commissioner or agent-general 
 in London ; and that these, with medical officers 
 representing the several departments in Whitehall, 
 
HEALTH AND THE BRITISH EMPIRE 359 
 
 and with an equal number of lay administrators, 
 permanently responsible for the consideration of 
 health matters in their respective governments or 
 departments, should constitute a permanent advisory 
 council, with London as its headquarters. The 
 members of this council must be chosen, not for their 
 skill and eminence as physicians or surgeons, but for 
 their experience and ability in connection with pre- 
 ventive medicine and physical improvement. This 
 body would take over the work of the scattered 
 advisory committees not merely departmental in 
 scope already existing ; it would divide its work 
 in departments, probably by diseases, on the analogy 
 of the sleeping sickness bureau and the advisory 
 committee on plague ; it would appoint special 
 committees for the consideration of special topics, and 
 would despatch missions under its own complete con- 
 trol, for local investigations of exceptional conditions. 
 During the last few years committees would thus, 
 with untold advantage, have been formed for the 
 consideration of Indian plague during the first eight 
 years of the outbreak, when nothing was done ; of 
 sleeping sickness before two-thirds of the population 
 of 300,000 in the infected district in Uganda had been 
 killed by it ; of beri-beri, tuberculosis and alcohol ; 
 of eugenics and the declining birth-rate ; of mid- 
 wifery and nursing ; of sanitary inspection and health- 
 visiting ; of physical training and health in schools ; 
 of public education in matters of health ; of the 
 changes required in medical education in view of the 
 different, the preventive task now demanded of 
 doctors by the state. 
 
360 HEALTH AND EMPIRE 
 
 Such a body would employ, for purposes of in- 
 spection and report, an ever-increasing staff, experi- 
 enced both in temperate and tropical sanitation from 
 the administrative standpoint. This inspectorate is 
 already to hand, waiting idle in this country with 
 nothing to do. Officers of the Indian, Naval, Army 
 and Colonial medical services have had a unique 
 experience of the kind required ; their records would 
 show their respective worth ; most retire in early 
 middle age, many even earlier ; few find congenial 
 work at home that will make use of their special 
 abilities and experiences. There are others, retired 
 from service under municipalities or district boards, 
 and doubtless many still engaged in all parts who 
 would gladly take engagement in such a service. 
 Laymen of experience would be no more difficult to 
 find. As the Local Government Board by its admir- 
 able inspectorate medical, engineering and archi- 
 tectural has acquired the respect of every district 
 in England and Wales, so would such an imperial 
 inspectorate earn for the advisory council proposed 
 the confidence and support of every government 
 throughout the empire. 
 
 EDUCATIONAL MEASURES 
 
 Much space was devoted in the earlier chapters of 
 this book to the fundamentally important question 
 of research. Excellent as is the work being done in 
 laboratories in all parts of the empire under the 
 encouragement of the home or Indian or dominion 
 governments, there is sore need for their co-ordina- 
 
HEALTH AND THE BRITISH EMPIRE 361 
 
 tion. In a campaign it is of little value for scouts to 
 be forging ahead, as chance may lead them, inde- 
 pendent of any direction and out of touch with the 
 forces they are to protect. All over the world much 
 time, money and labour are lost for lack of specific 
 direction of research ; still more are lost because the 
 workers, even under direction, work all day in their 
 laboratories and see nothing of work outside. It is 
 one thing for a scout to be guided by what he finds, 
 for the investigator to be open-minded and equally 
 critical of all results, however obvious ; it is quite 
 another thing to work without any guiding idea. 
 The most useful investigations are based, Darwin 
 said, on imagination, constantly revised. Both the 
 imagination and the revision can only usefully be 
 supplied by a body of world-wide outlook in a matter 
 so dependent as public health on the limits of immunity, 
 susceptibility and endurance in the human frame. 
 A central authoritative body, authorised by its effect- 
 ive scientific credit rather than by law, would use 
 these laboratories as a general will throw out his 
 scouts ; efforts would be concentrated, although not 
 confined, to one problem, even one aspect of each 
 problem, at a time. Every laboratory would be 
 as one mesh in the dredger's net, working slowly up- 
 stream, confident that nothing can escape its reach. 
 Every fact ascertained, yes or no, would be filed in 
 its place in the records of the imperial bureau ; every 
 worker would be enlisted in the general scheme and 
 inspired by common and effective direction. 
 
 Much too is lost through the common tendency to 
 specialism in research. As in clinical work so in 
 
362 HEALTH AND EMPIRE 
 
 public health, research and practice should go hand in 
 hand. The workers at present far too often live glued 
 to their microscopes and cut off from the outside 
 world. But the worker, above all, the director, in a 
 laboratory should be in frequent and responsible 
 touch with the actualities of the conditions he is 
 investigating ; he should either devote part of his 
 time to research, part to administrative duties ; or 
 he should take spells of service, first at one, then the 
 other. This comment is more necessary at home 
 than abroad ; more in civilian work than in the 
 government services, where research has constantly to 
 be justified and where duties are frequently changed. 
 
 It is suggested, then, that in these ways research may 
 be made far more effective and may so command a far 
 greater measure both of private and of official support. 
 
 Of the need of such support there is no question. 
 In comparison with the bacteria and other parasites 
 already known, the microbic worlds as yet unex- 
 plored are as the universe to a single spot of earth ; 
 in exploring the ultra-microscopic or ultra-violet or 
 any other fields outside the range of our present 
 instruments, we are in far worse case than Captain 
 Scott in seeking the Antarctic Pole. The fields are 
 beyond imagination ; we require endless work, well- 
 directed work, well-endowed work to attract the 
 permanent services of men of culture and thought and 
 to secure them the requisite freedom from monetary 
 care. The niggardly grants yet made by parlia- 
 ment for research are but mere drops in the ocean ; 
 and since parliament, we are told, represents the 
 electorate, it is the electorate and their leaders that 
 
HEALTH AND THE BRITISH EMPIRE 363 
 
 must bear the burden before the eternal judgment- 
 seat of those millions of preventable deaths in the 
 Punjab, inasmuch as they have starved the research 
 on which the remedy could alone be found. 
 
 There is no further need to endorse the proposal 
 recently put forward by Lord Northcote for an 
 Edward VII. Tropical Research Fund and warmly 
 supported by such representatives of imperial needs 
 as Lord Crewe and Lord Elgin, Lord Kitchener and 
 Lord Rothschild, Mr. Ramsay Macdonald and Mr. 
 Joseph Chamberlain. 
 
 The value of all this research work, especially in 
 relation to tropical conditions, has lain in the light it 
 has thrown on the whole science of preventive medi- 
 cine. But the education of the medical officer of health 
 remains the same, and it requires considerable altera- 
 tion. When the diploma in public health was first 
 instituted, sanitary engineers, as such, did not exist ; 
 and public health was mainly a question of water- 
 pipes and sewerage. The curriculum and examina- 
 tion were ordered accordingly. After a time bacterio- 
 logy was added to the course. But now sanitary 
 engineering may largely be left to the engineers ; 
 while public health is seen to depend far more on 
 personal influence and habit than on material circum- 
 stance. More applied physiology ; more attention 
 to the physical improvement of the individual is 
 required ; for the work of school-health has shifted 
 the basis of public health work. The course too 
 should require residence and practical experience for 
 a month in a small urban and the surrounding 
 rural districts. Moreover, the science of preventive 
 
364 HEALTH AND EMPIRE 
 
 medicine depends as we have seen on a far wider 
 range of experience than that of the British Isles ; 
 and tropical conditions of climate, government and 
 race supply a far wider and sounder basis of study 
 than those to which the teaching of public health is 
 at present confined. 
 
 Courses and examinations should be to some extent 
 altered in these directions ; provision should be made 
 for centralising the teaching for the diploma in the 
 London schools under a staff directed by a professor 
 able to make a wide and academic, as well as a prac- 
 tical study of the whole subject. But unfortunately 
 the body entrusted with the regulation of these 
 matters is ill-equipped for the purpose. 
 
 Mention has already been made of changes re- 
 quired in the general medical education to meet the 
 modern demand of the state for preventive rather 
 than curative medicine, for attention to the com- 
 munity rather than to the individual. Medical 
 education runs in a vicious circle. Physicians and 
 surgeons control medical education and naturally 
 educate their pupils to follow in their steps. If one 
 of those pupils takes up public health, there is no 
 room for him on the hospital staff, and he is thus 
 eliminated from the bodies that control the curriculum. 
 A hospital numbers fifty or sixty physicians on its 
 staff, but not a single representative of tropical or 
 veterinary medicine or of the public health. Fo r the 
 purposes of its medical school a local medical officer 
 of health is engaged to fill a subordinate and un- 
 remunerative position, and so satisfy the require- 
 ments of the examining boards. But medical 
 
HEALTH AND THE BRITISH EMPIRE 365 
 
 students complain bitterly of their ignorance on the 
 innumerable questions of public health they know 
 they will have to face in practice ; and the consultants 
 who rule the roost, in the schools, in the Royal Colleges 
 of Physicians and Surgeons, and in the medical 
 faculties of the universities, both for education and 
 examination, seem blind to the important part that 
 public health questions are likely to play in general 
 practice ; blind to the prospect that faces a large 
 proportion of medical students of practising, if only 
 for a time, in tropical climates without any knowledge 
 of tropical disease ; blind to the declining demand 
 for their own function and the increasing demand for 
 the prevention of illness ; blind to the inadequacy of 
 their own presentment of medical and surgical science. 
 The blame attaches not to them but to the vicious 
 circle established by custom and law. The circle 
 must be broken ; the constitution of the General 
 Medical Council must be revolutionised and the 
 whole curriculum and syllabus of examination be 
 completely revised in the light of new conditions and 
 new requirements. 
 
 But of even greater importance is the education 
 of the public in the importance of public health. 
 Disease is a calamity which essentially requires pro- 
 fessional attention and advice. But the maintenance 
 of health depends on the individual and can for the 
 most part be ensured by a careful and intelligent 
 way of life. He must certainly be defended against 
 the main attacks of disease by a proper system of 
 sanitation, devised and supervised by engineering, 
 veterinary and medical experts ; but here again the 
 
366 HEALTH AND EMPIRE 
 
 layman and the semi-lay woman, the nurse, are of 
 first importance. The first attention therefore should 
 be paid to the instruction of teachers in every school, 
 college and university throughout the empire in the 
 aims and methods of public as well as of personal 
 health. The enlightenment of the next generation 
 depends on the enlightenment of their teachers. 
 Physical welfare, for the citizen as for the soldier, is 
 the basis of his working strength ; and the basis 
 of every moral and spiritual development. Given 
 a proper system of sanitation and proper conditions 
 of work, every man's health, every woman's health, 
 and with their health to a large extent their happiness, 
 is in their own hands. Medical officers of health and 
 those who think with them should be given a large 
 share in the training of teachers. 
 
 As for the average citizen, so infinitely more for 
 the man and woman of position and influence a 
 proper training in public health is required. It -is 
 our boast that India, for instance, is ruled on the 
 whole exceeding well by a handful of young English- 
 men. It is our melancholy experience that the 
 Indian government has been powerless to check the 
 ravages of plague and to prevent the loss of 7,000,000 
 lives ; that so many millions die every year of malaria ; 
 so many millions more from other preventable causes. 
 How can Indian civilians be expected to devise or 
 in any large degree to approve the empiric methods 
 that should be adopted in an endeavour to find 
 a remedy ? At school and university lads are 
 crammed with knowledge of classics and mathe- 
 matics, history, languages, economics and law ; 
 
HEALTH AND THE BRITISH EMPIRE 367 
 
 and with this equipment they are sent out to rule 
 over provinces whose fortunes depend on agriculture 
 and are mainly threatened by disease. As for India 
 and the other British dominions, so also at home. 
 As professional men or officers in the services, church 
 or state ; as thinkers and writers ; as fathers and land- 
 lords ; above all, as magistrates and judges, councillors 
 and members of parliament, they are called on in 
 their turn to play their part in national prosperity. 
 The prosperity of the nation depends on its health ; 
 its health depends on care and attention in every 
 phase of life ; and this care, whether private or 
 public, depends very largely on public opinion. It is 
 the men from the public schools and universities 
 to-day that will form the public opinion of to-morrow. 
 In that sense w r e are at present taking no thought 
 for the morrow ; we are turning out a body of men 
 utterly ignorant and therefore indifferent to the 
 prevention of preventable disease and to their future 
 responsibilities in the maintenance of the public health. 
 The remedy for this must be gradually formed. Im- 
 mediate steps should be taken to establish lectureships 
 and professorships for the laity in every university, 
 to provide simple and attractive lectures and demon- 
 strations in every school, to include in the compulsory 
 syllabus of every final examination some knowledge 
 of the principles and methods of individual, national 
 and imperial health. 
 
 Much may be taught by museums and exhibitions, 
 which, dealing with familiar subjects, can easily be 
 made attractive. The crowded audiences at the 
 tuberculosis exhibitions of recent years have been a 
 
368 HEALTH AND EMPIRE 
 
 revelation of popular feeling. The museum for in- 
 struction in workmen's welfare at Berlin inspired a 
 scheme for a similar permanent museum in London, 
 now laid before the King Edward VII. Memorial 
 Committee for London by the National League for 
 Physical Education and Improvement. 
 
 If this be true of the men it is truer still of the 
 women. The habits of the household depend mainly 
 on the mother ; the influence of the woman on cleanli- 
 ness, rest, food and the other conditions essential to 
 health is supreme. Sick-nursing, midwifery and 
 health- visiting are essentially womanly occupations ; 
 it is on these that the main hope for improvement of 
 the national health must in no small measure depend ; 
 and every girl, in whatever station, should be taught 
 not merely the dry principles of " domestic hygiene," 
 but the practical application of these principles to 
 her own and to the national life. 
 
 The health of the people is the supreme law. If 
 this doctrine, properly interpreted, is thoroughly 
 ingrained into the popular imagination, there is little 
 doubt that the people will themselves demand that 
 far more attention shall be paid to matters of 
 health in the education of every child and in the 
 administration of every department of life. The 
 inevitable corollary is the co-operation of all the 
 governments of the empire to this end ; and it is 
 to be hoped that at the next meeting of the Imperial 
 Conference time may be found for the discussion of a 
 resolution presented to the conference of 1907 by 
 the Royal Sanitary Institute to the effect elaborated 
 in this final chapter. We of the British isles move 
 
HEALTH AND THE BRITISH EMPIRE 369 
 
 forward in the style of the kangaroo. In motors, in 
 aeroplanes, in national insurance, to take three recent 
 instances, we wait to use the experience of others ; 
 we then give a mighty leap and land ahead of those 
 who have inspired our move ; and there we stick 
 till the world has again gone past us. In wise and 
 liberal expenditure on education and research, and 
 again in imperial organisation, we are far behind both 
 the German Empire and the United States. Now at 
 the opening of a new reign, here more especially in 
 the question of the public health, is the occasion for 
 the next leap of the British kangaroo. So may his 
 Gracious Majesty King George be able to promote 
 the health and welfare of his empire and in future 
 days to say that ill-health, if preventable, has been 
 prevented. 
 
 " And the young king said : ' I have found it, 
 
 The road to the rest ye seek : 
 The strong shall wait for the weary, 
 The hale shall halt for the weak ; 
 With the even tramp of an army, 
 
 Where no man breaks from the line, 
 Ye shall march to peace and plenty 
 In the bond of brotherhood sign ! ' 
 RUDYARD KIPLING. " Anflmperial Rescript." 
 
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